In 2007, clinical leaders providing cardiac care to children from around the world convened at the Global Forum on Humanitarian Medicine in Cardiology and Cardiac Surgery in Geneva. Possible contributing factors of mortality specific to children undergoing cardiac surgery in developing countries were discussed. It became evident that few benchmarks exist to identify specific risk factors and to evaluate program performance in emerging world programs. In an effort to address these gaps, the International Quality Improvement Collaborative (IQIC) for Congenital Heart Surgery was launched. A database was created to track clinical outcomes of in-hospital and 30-day mortality, surgical site and bloodstream infections, and nutritional status.

The database was piloted from September 2008 to December 2009, and included the following sites: Unidad de Cirugia Cardiovascular de Guatemala (Guatemala); Armed Forces Institute of Cardiology (Pakistan); Frontier Lifeline Hospital (India); National Children’s Cardiac Surgical Center (Belarus); and Shanghai Children’s Medical Center (China).

Findings from the pilot indicated data collection on mortality and major complications is feasible among developing world programs, nutritional status is an important risk factor for mortality, and post-operative infections contribute significantly to mortality.

In 2010, nine additional sites joined the Collaborative and participated in data collection and online QI webinars, and by mid-2015, 44 sites in 20 countries were actively enrolled and engaged in the IQIC. Each site is responsible for the collection and entering of patient data into the database for benchmarking purposes and as of July 2015, data from nearly 40,000 surgical procedures have been submitted to the database. These sites also participate in online webinars that include content on QI strategies and subsequently strive to implement these strategies at their respective institutions.

Significance of the Problem

The establishment of surgical programs for children with congenital heart surgery in developing world programs is a major step toward improving surgical outcomes. Although congenital heart surgery in developing countries offers access to children who would otherwise die, surgery is particularly challenging and associated with high mortality. We hope to show that collaborations between developed and developing world programs can provide an opportunity to build sustainable quality-driven cardiac programs in resource-limited settings.