Fundação Getúlio Vargas (FGV), Escola de Administração de Empresas de São Paulo (EAESP), São Paulo, SP, Brazil.
Fundação Getúlio Vargas (FGV), Escola de Administração de Empresas de São Paulo (EAESP), São Paulo, SP, Brazil.
J Pediatr (Rio J). 2024 Jan-Feb;100(1):88-92. doi: 10.1016/j.jped.2023.08.005. Epub 2023 Sep 21.
To analyze access to surgical care for congenital heart diseases in public specialized centers in the state of São Paulo before and during the COVID-19 pandemic and availability of surgical care in specialized hospitals, to identify bottlenecks in the care path for neonatal cardiac surgery.
This study included 1,437 children, under one year old, with congenital heart disease and formal referral to heart surgery between February 1, 2019, and February 28, 2021. Quantitative data analysis was performed using t-tests or the Mann-Whitney test.
Approximately 30 % of children with urgent congenital heart disease could not access recommended care, mainly those needing complex surgeries (categories RACHS 4 to 6). The main diagnoses of neonates accessing care were patency of the ductus arteriosus (10.5 %) and coarctation of the aorta (10.1 %). Referral time for children in RACHS 1 to 3 was 4 days (median), while for those in categories 4 to 6, it was 7 days (p < 0.001). Longer referral time (20 days) was associated with court orders. During the pandemic, referral time decreased to 3 days, compared to 5 days (median) in the pre-pandemic period (p < 0.001).
The emergency surgical treatment supply for congenital heart diseases is insufficient compared to the current demand. Future research should evaluate if access to care in publicly funded hospitals could be improved by better access to prenatal care for pregnant women, increased diagnostic and therapeutic capacity in pediatric cardiology, and financial incentives for complex cardiac surgeries.
分析 COVID-19 大流行前后圣保罗州公立专科医院先天性心脏病手术治疗的可及性，以及专科医院心脏手术的开展情况，以确定新生儿心脏手术治疗路径中的瓶颈。
本研究纳入了 2019 年 2 月 1 日至 2021 年 2 月 28 日期间，1437 名 1 岁以下患有先天性心脏病且有正式心脏手术转诊需求的儿童。采用 t 检验或曼-惠特尼检验进行定量数据分析。
约 30%有紧急先天性心脏病的儿童无法获得推荐的治疗，主要是那些需要复杂手术的儿童（RACHS 分类 4-6 类）。接受治疗的新生儿的主要诊断为动脉导管未闭（10.5%）和主动脉缩窄（10.1%）。RACHS 1-3 类患儿的转诊时间为 4 天（中位数），而 RACHS 4-6 类患儿的转诊时间为 7 天（p<0.001）。转诊时间较长（20 天）与法院命令有关。与大流行前相比（中位数为 5 天），大流行期间转诊时间缩短至 3 天（p<0.001）。
与当前需求相比，先天性心脏病的紧急手术治疗供应不足。未来的研究应评估通过增加孕妇产前护理的可及性、提高儿科心脏病学的诊断和治疗能力以及为复杂心脏手术提供财政激励，是否可以改善公共资助医院的就诊机会。
