Access to paediatric cardiac surgery in Colombia: a population-based study

Abstract

OBJECTIVES Globally congenital heart disease mortality is declining, yet the proportion of infant deaths attributable to heart disease rises in Colombia and other middle-sociodemographic countries. We aimed to assess the accessibility of paediatric cardiac surgery (PCS) to children <18 years of age in 2016 in the South American country of Colombia. METHODS In Bogotá, Colombia, a multi-national team used cross-sectional and retrospective cohort study designs to adapt and evaluate 4 health system indicators at the national level: first, the population with timely geographic access to an institution providing PCS; second, the number of paediatric cardiac surgeons; third, this specialized procedure volume and its national distribution; and fourth, the 30-day perioperative mortality rate after PCS in Colombia. RESULTS Geospatial mapping approximates 64% (n = 9 894 356) of the under-18 Colombian population lives within 2-h drivetime of an institution providing PCS. Twenty-eight cardiovascular surgeons report performing PCS, 82% (n = 23) with formal training. In 2016, 1281 PCS procedures were registered, 90% of whom were performed in 6 of the country’s 32 departments. National non-risk-adjusted all-cause 30-day perioperative mortality rate after PCS was 2.73% (n = 35). CONCLUSIONS Colombia’s paediatric population had variable access to cardiac surgery in 2016, largely dependent upon geography. While the country may have the capacity to provide timely, high-quality care to those who need it, our study enables future comparative analyses to measure the impact of health system interventions facilitating healthcare equity for the underserved populations across Colombia and the Latin American region.

Barriers to healthcare access for children with congenital heart disease in eight Latin American countries

“…It is estimated that of the 41 000 cardiac surgeries required in 2007 in this region, only 17 019 were performed, and in countries such as Ecuador or Paraguay, the lack of coverage reaches levels as high as 80%. 10 As is the case in other contexts, access barriers may also be related to geographic, 11 cultural, educational, 12 and psychological factors of the children's parents/guardians. 13 Furthermore, access to health care in LA for this population could also be related to factors such as healthcare system and policies and the level of resources in each country.…”

“…14 There is little information regarding the barriers to access to health care perceived by the parents/guardians of children with CHD in LA, highlighting the relevance of geographic issues. [10][11][12] Understanding the barriers to access to care is of paramount importance for the design and implementation of policies to increase the provision of care. The main objective of this study is to investigate the perception of barriers to access to health care by parents/guardians of children with CHD in selected LA countries.…”

“…On the contrary, Sabatino showed that Colombian children had variable access to cardiac surgery, depending on their geographical characteristics 11 . However, these studies use different methodologies (population estimates and patient records to quantify surgeries, 11 patient records to assess late surgeries, 12 and questionnaires to parents/guardians of children), which could explain this difference. Moreover, as Sandoval et al., reports, 10 the countries where there are more surgical teams are not those that necessarily have a smaller coverage deficit.…”

“…There is little information regarding the barriers to access to health care perceived by the parents/guardians of children with CHD in LA, highlighting the relevance of geographic issues 10–12 . Understanding the barriers to access to care is of paramount importance for the design and implementation of policies to increase the provision of care.…”

Mortalidad perioperatoria en Tolima, perspectivas del cuarto indicador de The Lancet Commission on Global Surgery: un análisis preliminar de la cohorte prospectiva del estudio Colombian Surgical Outcomes Study (ColSOS)

“…En este análisis inicial relacionamos la tasa de mortalidad perioperatoria en el departamento de Tolima. Este abordaje permite obtener datos más actualizados y representativos en nuestro territorio, en contraste con la evidencia que ofrecen los estudios retrospectivos 5,[18][19][20][21] .…”