Pediatric cardiac surgery in Colombia.

Abstract

In countries such as the USA, paediatric cardiac surgical teams compete with one another for patients and there is little enthusiasm for centralization of specialist care. The reverse may be true in many other parts of the world, especially those with more limited resources. Colombia is a beautiful and diverse country that views healthcare as a basic right for its citizens. Among 191 nations assessed by the World Health Organization for overall efficiency of health care, Colombia was ranked 22, well ahead of the USA and some more affluent European nations. However, despite the availability of excellent paediatric cardiac surgery, the proportion of infant deaths from heart disease in Colombia was noted by the authors to be increasing [1]. Colombia is blessed with some extreme geography, and this must be taken into account in the analysis of maldistribution of children’s health care. Especially important are the effects on the transportation of neonates with critical cardiac problems. The present analysis is based on 4 access indicators developed by The Lancet Commission on Global Surgery, in this case looking specifically at paediatric cardiac surgery [2]. Provision of timely geographic access was assessed using some novel and convincing analytic techniques. Analysis of adequacy of the workforce, surgical volume, and risk adjusted operative mortality are provided. Timely access to care (<2 h, based in part on the time to effect of PGE-1) was estimated to be available for only 64% of children in need. On the other hand, results of surgical treatment were excellent, despite some notable variations in surgeon and centre volume, and an overall paucity of providers. Inevitably, access to healthcare (including paediatric cardiac surgery) was linked to socioeconomic status within the country. Sabatino et al. [1] provide herein an interesting look at the paediatric cardiac sector of the Colombian health care system, and an incentive to look beyond care in specialized centres in the analysis of risk. This thoughtful study sets a standard, and may help institutions and governments to implement better paediatric cardiac registries. This in turn may influence planning, organization, and resource allocation to improve results and coverage in paediatric cardiac surgery, in Colombia and other parts of the world.