title: Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: a single center experience in a developing economy.
abstract: BACKGROUND
  The International Quality Improvement Collaborative (IQIC) for Congenital Heart Surgery in Developing Countries was initiated to decrease mortality and major complications after congenital heart surgery in the developing world.
  
  
  OBJECTIVE
  We sought to assess the impact of IQIC on postoperative outcomes after congenital heart surgery at our institution.
  
  
  METHODS
  The key components of the IQIC program included creation of a robust worldwide database on key outcome measures and nurse education on quality driven best practices using telemedicine platforms. We evaluated 1702 consecutive patients ≤18 years undergoing congenital heart surgery in our institute from January 2010-December 2012 using the IQIC database. Preoperative variables included age, gender, weight at surgery and surgical complexity as per the RACHS-1 model. The outcome variables included, in- hospital mortality, duration of ventilation, intensive care unit (ICU) stay, bacterial sepsis and surgical site infection.
  
  
  RESULTS
  The 1702 patients included 771(45.3%) females. The median age was 8 months (0.03-216) and the median weight was 6.1Kg (1-100). The overall in-hospital mortality was 3.1%, Over the three years there was a significant decline in bacterial sepsis (from 15.1%, to 9.6%, P < 0.001), surgical site infection (11.1% to 2.4%, P < 0.001) and duration of ICU stay from 114(8-999) hours to 72 (18-999) hours (P < 0.001) The decline in mortality from (4.3% to 2.2%) did not reach statistical significance.
  
  
  CONCLUSIONS
  The inclusion of our institution in the IQIC program was associated with improvement in key outcome measures following congenital heart surgery over a three year period.
authors.forename: Rakhi
authors.initials: R
authors.lastname: Balachandran
authors.forename: Mahesh
authors.initials: M
authors.lastname: Kappanayil
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India.
authors.forename: Amitabh Chanchal
authors.initials: AC
authors.lastname: Sen
authors.forename: Abhish
authors.initials: A
authors.lastname: Sudhakar
authors.forename: Suresh G
authors.initials: SG
authors.lastname: Nair
authors.forename: G S
authors.initials: GS
authors.lastname: Sunil
authors.forename: R Benedict
authors.initials: RB
authors.lastname: Raj
authors.forename: Raman Krishna
authors.initials: RK
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D003906:Developing Countries; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D007391:International Cooperation; D008297:Male; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies; D016896:Treatment Outcome