P. J. Davis FRACS; Z. Wainer BMBS; M. O'Keefe MBBS; P. Nand FRACS.
Cardiac surgery in the Pacific Islands
Article first published online: 1 DEC 2011
© 2011 The Authors. ANZ Journal of Surgery © 2011 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 81, Issue 12, pages 871–875, December 2011
How to Cite
Davis, P. J., Wainer, Z., O'Keefe, M. and Nand, P. (2011), Cardiac surgery in the Pacific Islands. ANZ Journal of Surgery, 81: 871–875. doi: 10.1111/j.1445-2197.2011.05899.x
This paper was presented at the New Zealand Cardiac Surgery Meeting, Rotorua, New Zealand, April 2009.
- Issue published online: 1 DEC 2011
- Article first published online: 1 DEC 2011
- Accepted for publication 19 May 2011.
- delivery of health care;
- heart valve prosthesis implantation/mortality;
- rheumatic heart disease/surgery;
- risk assessment;
- risk factors
Background: Rheumatic heart disease constitutes a significant disease burden in under-resourced communities. Recognition of the devastating impact of rheumatic heart disease has resulted in volunteer cardiac teams from Australasia providing surgical services to regions of need. The primary objective of this study was to compare New Zealand hospitals' volunteer cardiac surgical operative results in Samoa and Fiji with the accepted surgical mortality and morbidity rates for Australasia.
Methods: A retrospective review from seven volunteer cardiac surgical trips to Samoa and Fiji from 2003 to 2009 was conducted. Patient data were retrospectively and prospectively collected. Preoperative morbidity and mortality risk were calculated using the European System for Cardiac Operative Risk Evaluation (euroSCORE). Audit data were collated in line with the Australasian Society of Cardiac and Thoracic Surgeons guidelines.
Results: One hundred and three operations were performed over 6 years. EuroSCORE predicted an operative mortality of 3.32%. In-hospital mortality was 0.97% and post-discharge mortality was 2.91%, resulting in a 30-day mortality of 3.88%.
Conclusion: This study demonstrated that performing cardiac surgery in Fiji and Samoa is viable and safe. However, the mortality was slightly higher than predicted by euroSCORE. Difficulties exist in predicting mortality rates in patients with rheumatic heart disease from Pacific Island nations as known risk scoring models fail to be disease, ethnically or culturally inclusive. Audit processes and risk model development and assessment are an essential part of this complex surgical charity work and will result in improved patient selection and outcomes.