title: Reducing mortality and infections after congenital heart surgery in the developing world.
abstract: BACKGROUND
  There is little information about congenital heart surgery outcomes in developing countries. The International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries uses a registry and quality improvement strategies with nongovernmental organization reinforcement to reduce mortality. Registry data were used to evaluate impact.
  
  
  METHODS
  Twenty-eight sites in 17 developing world countries submitted congenital heart surgery data to a registry, received annual benchmarking reports, and created quality improvement teams. Webinars targeted 3 key drivers: safe perioperative practice, infection reduction, and team-based practice. Registry data were audited annually; only verified data were included in analyses. Risk-adjusted standardized mortality ratios (SMRs) and standardized infection ratios among participating sites were calculated.
  
  
  RESULTS
  Twenty-seven sites had verified data in at least 1 year, and 1 site withdrew. Among 15,049 cases of pediatric congenital heart surgery, unadjusted mortality was 6.3% and any major infection was 7.0%. SMRs for the overall International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries were 0.71 (95% confidence interval [CI] 0.62-0.81) in 2011 and 0.76 (95% CI 0.69-0.83) in 2012, compared with 2010 baseline. SMRs among 7 sites participating in all 3 years were 0.85 (95% CI 0.71-1.00) in 2011 and 0.80 (95% CI 0.66-0.96) in 2012; among 14 sites participating in 2011 and 2012, the SMR was 0.80 (95% CI 0.70-0.91) in 2012. Standardized infection ratios were similarly reduced.
  
  
  CONCLUSIONS
  Congenital heart surgery risk-adjusted mortality and infections were reduced in developing world programs participating in the collaborative quality improvement project and registry. Similar strategies might allow rapid reduction in global health care disparities.
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts; kathy.jenkins@cardio.chboston.org.
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Jenkins
authors.affiliation: Unidad de Cirugía Cardiovascular Pediátrica de Guatemala, Guatemala City, Guatemala;
authors.forename: Aldo R
authors.initials: AR
authors.lastname: Castañeda
authors.affiliation: Frontier Lifeline Hospital, Chennai, India;
authors.forename: K M
authors.initials: KM
authors.lastname: Cherian
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts;
authors.forename: Chris A
authors.initials: CA
authors.lastname: Couser
authors.affiliation: Children's HeartLink, Minneapolis, Minnesota;
authors.forename: Emily K
authors.initials: EK
authors.lastname: Dale
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts;
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts;
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Hickey
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts;
authors.forename: Jennifer
authors.initials: J
authors.lastname: Koch Kupiec
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts;
authors.forename: Debra Forbes
authors.initials: DF
authors.lastname: Morrow
authors.affiliation: International Children's Heart Foundation, Memphis, Tennessee; University of Tennessee Health Sciences Center, Memphis, Tennessee; and.
authors.forename: William M
authors.initials: WM
authors.lastname: Novick
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts;
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.affiliation: Children's HeartLink, Minneapolis, Minnesota;
authors.forename: Bistra
authors.initials: B
authors.lastname: Zheleva
authors.affiliation: University Hospital Geneva, Geneva, Switzerland.
authors.forename: Jan T
authors.initials: JT
authors.lastname: Christenson
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality* / Q000592:standards; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D058996:Quality Improvement / Q000592:standards; D012042:Registries / Q000592:standards; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*
keywords: congenital heart surgery; hospital-acquired infection; mortality; quality improvement