The workload, outcome and waiting time of cardiothoracic operations: a single unit study in Sri Lanka

Abstract

Introduction: Heart disease is the commonest cause of death worldwide. Its surgical treatment is expensive, and resources are limited. Although there is general concern regarding the work of cardiothoracic units in Sri Lanka, there is very little scientific data regarding it. Our objective was to establish the workload, outcome and waiting time of cardiothoracic operations in a single unit in Sri Lanka. Methods: Prospectively entered data from the clinic register and operation logbooks from August 2010 to March 2020 were reviewed retrospectively and collected on data extraction sheets. The data was entered onto a Microsoft EXCEL database and analyzed using SPSS [Statistical Package for Social Sciences]. Results: In 1100 patients, 759 [69%] were males and 341[31%], females; The mean age was 50.8 years [1 day-77 years]. Coronary artery bypass grafting [CABG] was the commonest operation [573;52.1%]. Others were thoracic operations [207;18.8%], valve operations [160;14.5%], congenital operations [89;7.8%], Extracorporeal Membrane Oxygenation/ECMO [29;2.6%], cardiothoracic trauma [20;1.8%], cardiac tumours [14;1.3%] and aortic operations [6;0.5%]. Urgency categories were elective [855;77.7%], urgent [179;16.3%], emergency [36;3.3%] and salvage [30;2.7%]. The mortality rate for elective surgery was 3.3% and that of CABG, 2.4%. The recent death rate while waiting is 5.7%. The present waiting time for elective operations is 9.4 months and is increasing. Conclusions: Coronary, thoracic and valvular operations are the commonest operations in this unit. The outcomes of surgery are within accepted international standards. The waiting time is long. This study provides a baseline for future research and audit to prioritize capacity building.