Critical pathway, cardiac surgery in the third world

ABSTRACT

To set up a protocol in order to provide an efficient, cost effective system for Cardiac Surgery and to reduce the waiting list in straight forward Cardiac Surgical Operations. A prospective study in all patients with Patent Ductus Arteriosus [PDA] following the Critical Care Methodology. Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore. Main outcome measures: Effectiveness of critical care methodology, reduction of cost to hospital and patient and reduction in waiting list time for PDA surgery. From June 1994 till June 1999, one hundred and fifty consecutive patients of PDA had their operation planned as day case cardiac surgery. There were 90 females and 60 males. Their mean age was 6.55 +/- 0.56 years. 134 patients were less than 18 years, mean age 4.9 +/- 0.39 years. These patients were seen in the outpatient and were accessed by the surgeon, anesthetist and intensive care sister. The parents of the children were fully briefed about the preoperative preparation, operation and post operative course. The patients were admitted on the day of the operation and kept in the ICU for 6 hours and then shifted to the high dependency unit [HDU] and discharged on the second post operative morning. We found this method of day case surgery beneficial for the patient. In that it reduced the cost of the hospital stay, surgery and led to a reduction in the waiting list time for PDA. This did not lead to an increase in the morbidity as the patients were sent home to the community early. In third world countries like Pakistan where resources are limited this method is ideal provided everyone is willing to participate