Key result
Local cardiac surgery teams are linked to ~82% higher odds of postoperative complications versus foreign teams.
Why the study?
Congenital heart defects are the predominant pediatric congenital anomaly in Yemen, and the outcomes of pediatric cardiac surgery comparing foreign and local surgical teams were unknown.
Does cardiac surgery performed by local teams compared to foreign teams affect complications and mortality in pediatric patients with congenital heart defects?
Cohort (n=2,052)
No
Does cardiac surgery performed by local teams compared to foreign teams affect complications and mortality in pediatric patients with congenital heart defects?
Odds Ratio: 1.821 (95% CI 1.472–2.254)
Absolute Event Rate: 40.6% vs 31.3%
p-value: p=<0.001
Local surgical teams in Yemen achieved comparable mortality rates to foreign teams for pediatric congenital heart surgery, though with higher complication rates and extended hospital stays.
Comparable mortality with local teams supports capacity building in low-resource settings; leaves open whether training reduces higher complications.
BACKGROUND: Congenital heart defects (CHDs) constitute the predominant pediatric congenital anomaly in Yemen, substantially contributing to childhood morbidity and mortality. AIM: This study aimed to investigate the outcomes of pediatric cardiac surgery, specifically comparing results between foreign and local surgical teams. METHOD: A retrospective cohort study was conducted using data from January 2004 to December 2019, sourced from a local electronic database and manual registration system. Demographic information, in-hospital complications, mortality, and length of stay were analyzed. The Aristotle Basic Complexity Score (ABC score) was used to categorize surgical procedures. RESULTS: The cohort of 2052 patients experienced an overall complication rate of 36.2% and a mortality rate of 6.4%. Extended hospital stays (> 7 days) were associated with a higher complication rate (p < .001). Less complex procedures demonstrated lower complication and mortality rates. Surgical complexity and prolonged hospital stays were identified as predictors of postoperative complications and mortality. While the local team was a predictor of postoperative complications. Notably, mortality did not significantly differ between foreign and local teams (p = .194). CONCLUSION: Local teams successfully increased surgery volume while achieving comparable mortality rates to foreign teams. However, higher complication rates and extended hospital stays persist for cases managed by local teams, underscoring the need for targeted training and resource optimization.
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Alansi et al. (2025) conducted a cohort in Congenital heart defects (n=2,052). Local surgical team vs. Foreign surgical team was evaluated on Postoperative complications (OR 1.821, 95% CI 1.472-2.254, p=<0.001). Cardiac surgeries performed by local teams were associated with a significantly higher rate of postoperative complications compared to foreign teams (40.6% vs 31.3%, OR 1.821), while mortality rates did not significantly differ.
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