Falase Bode, Olufemi Setemi, Ikotun Funmilayo, Daniel Folasade, Idowu Ariyo, Khodaverdian Reza, Farkas Emily
Cardiothoracic Division, Lagos State University Teaching Hospital, Lagos, Nigeria.
Anaesthesia Department, Lagos State University Teaching Hospital, Lagos, Nigeria.
Semin Thorac Cardiovasc Surg. 2024 Winter;36(4):398-410. doi: 10.1053/j.semtcvs.2023.05.002. Epub 2023 Aug 1.
Open-Heart Surgery at the Lagos State University Teaching Hospital commenced in 2004. Early years were based on a Cardiac Mission Model, but since 2017 the focus was on the transition to a Local Team Model with autonomous Open-Heart Surgery. The aim of this study is to describe our progress in making this transition, highlight lessons learned, and detail the outstanding challenges to be overcome. This study is a retrospective analysis of prospectively maintained data from the Lagos State University Teaching Hospital cardiothoracic database and Nigeria Open-Heart Surgery Registry between November 2004 and December 2021. Data extracted included patient demographics, EuroSCORE II, operative procedure, operative category, lead surgeon, complications, and outcomes. Over the study period, 100 operations were done over 2 time periods, 51 operations between 2004 and 2011 (Cardiac Mission Period) and 49 operations between 2017 and 2021 (Transition Period). In the Cardiac Mission Period, 21.6% of the operations were done by the Local Team and in the Transition Period this increased to 85.7% of the operations completed. Overall mortality was 14%, dropping from 17.6% in the Cardiac Mission Period to 10.2% in the Transition Period. The Local Team is now gradually taking on more diverse cases while striving to maintain good outcomes. Our institution has successfully made the transition from Cardiac Missions to Autonomous Open-Heart Surgery without an increase in mortality and a gradual increase in surgical volumes. Lessons learned included a strategy to focus on adult surgery, avoidance of high-risk cases, and moving from free surgery toward an appropriate cost structure for program sustainability. Contributory factors to the successful transition include the active support of the hospital management (provision of appropriate infrastructure and equipment, investment in training of the Local Team), continued humanitarian international collaborations focused on skill transfer, and maintenance of Local Team skills by collaborations with other active cardiac centers in Nigeria. Remaining challenges include financing to bridge equipment gaps, maintenance and replacement of equipment as well as the evolution of a national health insurance schema that would ideally support Open-Heart Surgery for Nigerian patients. Until that time, patients and programs must rely on supplemental funding of surgery to increase surgical volumes.
拉各斯州立大学教学医院的心脏直视手术始于2004年。早期采用心脏使命模式，但自2017年以来，重点是向具有自主心脏直视手术能力的本地团队模式转变。本研究的目的是描述我们在这一转变过程中的进展，突出吸取的经验教训，并详细说明有待克服的突出挑战。本研究是对拉各斯州立大学教学医院心胸外科数据库和尼日利亚心脏直视手术登记处2004年11月至2021年12月前瞻性收集的数据进行的回顾性分析。提取的数据包括患者人口统计学信息、欧洲心脏手术风险评估系统II、手术操作、手术类别、主刀医生、并发症和手术结果。在研究期间，分两个时间段进行了100例手术，2004年至2011年（心脏使命期）进行了51例手术，2017年至2021年（过渡期）进行了49例手术。在心脏使命期，21.6%的手术由本地团队完成，在过渡期，这一比例增至85.7%。总体死亡率为14%，从心脏使命期 的17.6%降至过渡期的10.2%。本地团队目前正在逐渐承担更多样化的病例，同时努力保持良好的手术效果。我们的机构已成功从心脏使命模式转变为自主心脏直视手术模式，且死亡率没有增加，手术量逐渐上升。吸取的经验教训包括专注于成人手术的策略、避免高风险病例以及从免费手术转向适当的成本结构以实现项目可持续性。成功转型的促成因素包括医院管理层的积极支持（提供适当的基础设施和设备、对本地团队进行培训投资）、持续开展专注于技能转移的人道主义国际合作以及通过与尼日利亚其他活跃的心脏中心合作来维持本地团队的技能。剩余的挑战包括填补设备缺口的资金、设备的维护和更换，以及理想情况下能够支持尼日利亚患者进行心脏直视手术的国家医疗保险计划的发展。在此之前，患者和项目必须依靠手术的补充资金来增加手术量。
