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Comparison of outcomes in Australian indigenous and non-indigenous children and adolescents undergoing cardiac surgery

Published online by Cambridge University Press:  01 June 2017

Edward R. Justo ,
Benjamin M. Reeves ,
Robert S. Ware ,
Janelle C. Johnson ,
Tom R. Karl ,
Nelson D. Alphonso  and
Robert N. Justo
Edward R. Justo
Affiliation:
University of Queensland, Brisbane, Australia
Benjamin M. Reeves
Affiliation:
Cairns Base Hospital, Cairns, Australia
Robert S. Ware
Affiliation:
University of Queensland, Brisbane, Australia Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
Janelle C. Johnson
Affiliation:
Queensland Paediatric Cardiac Service, Lady Cilento Children’s Hospital, Brisbane, Australia
Tom R. Karl
Affiliation:
University of Queensland, Brisbane, Australia Department of Cardiac Surgery, John Hopkins All Children’s Hospital, St Petersburg, Florida, United States of America
Nelson D. Alphonso
Affiliation:
University of Queensland, Brisbane, Australia Queensland Paediatric Cardiac Service, Lady Cilento Children’s Hospital, Brisbane, Australia
Robert N. Justo*
Affiliation:
University of Queensland, Brisbane, Australia Queensland Paediatric Cardiac Service, Lady Cilento Children’s Hospital, Brisbane, Australia
*
Correspondence to: Associate Professor R. N. Justo, Queensland Paediatric Cardiac Service, Lady Cilento Children’s Hospital, 501 Stanley Street, South Brisbane, QLD 4101, Australia. Tel: +617 3068 5108; Fax: +617 3068 3169; E-mail: [email protected]
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Abstract

Background

Population-based registries report 95% 5-year survival for children undergoing surgery for CHD. This study investigated paediatric cardiac surgical outcomes in the Australian indigenous population.

Methods

All children who underwent cardiac surgery between May, 2008 and August, 2014 were studied. Demographic information including socio-economic status, diagnoses and co-morbidities, and treatment and outcome data were collected at time of surgery and at last follow-up.

Results

A total of 1528 children with a mean age 3.4±4.6 years were studied. Among them, 123 (8.1%) children were identified as indigenous, and 52.7% (62) of indigenous patients were in the lowest third of the socio-economic index compared with 28.2% (456) of non-indigenous patients (p⩽0.001). The indigenous sample had a significantly higher Comprehensive Aristotle Complexity score (indigenous 9.4±4.2 versus non-indigenous 8.7±3.9, p=0.04). The probability of having long-term follow-up did not differ between groups (indigenous 93.8% versus non-indigenous 95.6%, p=0.17). No difference was noted in 30-day mortality (indigenous 3.2% versus non-indigenous 1.4%, p=0.13). The 6-year survival for the entire cohort was 95.9%. The Cox survival analysis demonstrated higher 6-year mortality in the indigenous group – indigenous 8.1% versus non-indigenous 5.0%; hazard ratio (HR)=2.1; 95% confidence intervals (CI): 1.1, 4.2; p=0.03. Freedom from surgical re-intervention was 79%, and was not significantly associated with the indigenous status (HR=1.4; 95% CI: 0.9, 1.9; p=0.11). When long-term survival was adjusted for the Comprehensive Aristotle Complexity score, no difference in outcomes between the populations was demonstrated (HR=1.6; 95% CI: 0.8, 3.2; p=0.19).

Conclusion

The indigenous population experienced higher late mortality. This apparent relationship is explained by increased patient complexity, which may reflect negative social and environmental factors.

Keywords

Congenital heart surgeryindigenousoutcomes
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1694 - 1700
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Copyright
© Cambridge University Press 2017 

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References

1. Erikssen, G, Liestol, K, Seem, E, et al. Achievement in congenital heart surgery: a prospective 40-year study of 7038 patients. Circulation 2015; 131: 337–346.Google Scholar
2. Raissadati, A, Nieminen, H, Jokinen, E, Sairanen, H. Progress in late results among pediatric cardiac surgery patients: a population-based 6-decade study with 98% follow-up. Circulation 2015; 131: 347–353.Google Scholar
3. Oster, ME, Strickland, MJ, Mahle, WT. Racial end ethnic disparities in post-operative mortality following congenital heart surgery. J Pediatr 2011; 159: 222–226.Google Scholar
4. Benavidez, OJ, Gauvreau, K, Jenkins, KJ. Racial and ethnic disparities in mortality following congenital heart surgery. Pediatr Cardiol 2006; 27: 321–328.Google Scholar
5. Bolisetty, S, Daftary, A, Ewald, D, Knight, B, Wheaton, G. Congenital heart defects in central Australia. Med J Australia 2004; 180: 614–617.CrossRefGoogle ScholarPubMed
6. Bower, C, Ramsay, JM. Congenital heart disease: a 10-year cohort. Paediatr Child Health 1994; 30: 414–418.Google Scholar
7. Alizzi, AM, Knight, JL, Tully, PJ. Surgical challenges in rheumatic heart disease in the Australian indigenous population. Heart Lung Circ 2010; 19: 295–298.Google Scholar
8. Weimers, P, Marney, L, Muller, R, et al. Cardiac surgery in indigenous Australians – how wide is the gap? Heart Lung Circ 2014; 23: 265–272.Google Scholar
9. Prabhu, A, Tully, PJ, Bennetts, JS, Tuble, SC, Baker, RA. The morbidity and mortality outcomes of indigenous Australian peoples after isolated coronary artery bypass surgery: the influence of geographic remoteness. Heart Lung Circ 2013; 22: 599–605.Google Scholar
10. Russell, EA, Tran, L, Baker, RA, et al. A review of outcome following valve surgery for rheumatic heart disease in Australia. BMC Cardiovasc Disord 2015; 15: 103–115.Google Scholar
11. Padley, JR, Cole, AD, Pye, VE, et al. Five-year analysis of operative mortality and neonatal outcomes in congenital heart disease. Heart Lung Circ 2011; 20: 460–467.Google Scholar
12. Rohde, SL, Matebele, M, Pohlner, P, Radford, D, Wall, D, Fraser, JF. Excellent cardiac surgical outcomes in paediatric indigenous patients, but follow-up difficulties. Heart Lung Circ 2010; 19: 517–522.Google Scholar
13. Pink, B. Socio-economic indexes for areas (SEIFA). Australian Bureau of Statistics; Catalogue Number 2033.0.55.001; 2013: 1–81.Google Scholar
14. Lacour-Gayet, F, Clark, D, Jacobs, J, et al. The Aristotle score for congenital heart surgery. Semin Thorac Cardiovasc Pediatr Card Surg Annu 2004; 7: 185–191.Google Scholar
15. Austin, PC. Optimal caliper widths for propensity score-matching when estimating differences in means and differences in proportions of observational studies. Pharm Stat 2011; 10: 150–161.Google Scholar
16. Austin, PC. An introduction to propensity score methods for reducing effects of confounding in observational studies. Multivariate Behav Res 2011; 46: 399–424.Google Scholar
17. Queensland Office of Economic and Statistical Research. Census 2011: Aboriginal and Torres Strait Islander Population in Queensland, 2nd edn; 2013. Retrieved August 10, 2015 from www.oesr.qld.gov.au Google Scholar
18. Atler, DA. Merits and pitfalls of using observational ‘big data’ to inform our understanding of socioeconomic outcome disparities. J Am Coll Cardiol 2015; 66: 1898–1900.Google Scholar
19. Dalen, M, Ivert, T, Holzmann, MJ, Sartipy, U. Household disposable income and long-term survival after cardiac surgery: a Swedish nationwide cohort study in 100,534 patients. J Am Coll Cardiol 2015; 66: 1888–1897.Google Scholar
20. Reeve, C, Humphreys, J, Wakerman, J, Carter, M, Carroll, V, Reeve, D. Strengthening primary health care: achieving health gains in a remote region of Australia. Med J Aust 2015; 202: 483–488.CrossRefGoogle Scholar
21. Zhao, Y, Thomas, SL, Guthridge, SL, Wakerman, J. Better health outcomes at lower costs: the benefits of primary care utilization for chronic disease management in remote Indigenous communities in Australia’s Northern Territory. BMC Health Serv Res 2014; 14: 463–472.CrossRefGoogle ScholarPubMed
22. Sly, JL, Moore, SE, Gore, F, et al. Children’s environmental health indicators in Australia. Ann Global Health 2016; 82: 156–168.Google Scholar
23. Australian Institute of Health and Welfare (AIWH). Better Cardiac Care Measures for Aboriginal and Torres Strait Islander People: First National Report 2015. Catalogue Number IHW 156. AIWH, Canberra; 2015: 44–50.Google Scholar
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