Pediatric Heart Surgery Waiting Time in Thailand and Its Effect on Mortality: A Cooperative Study from Chulalongkorn, Children and Chiang Mai University Hospitals
Apichai Khongphatthanayothin MD*, Thanarat Layangool MD**, Rekwan Sittiwangkul MD***, Yupada Pongprot MD***, Pornthep Lertsapcharoen MD*, Pirapat Mokarapong MD****.
Affiliation : * Chulalongkorn University ** Queen Sirikit National Institute of Child Health (Children Hospital) *** Chiang Mai University Hospital **** Rajavithi Hospital
Background : Thai children who need cardiac surgery are often put on a waiting list. The waiting time and
mortality during waiting have not been previously systematically studied.
Materials and Methods : A cooperative study was conducted at King Chulalongkorn Memorial hospital (Chula),
Children hospital (CH), and Chiang Mai University hospital (CMU). The status of children who were referred
for cardiac surgery at these hospitals in the year 1999-2000 (Chula and CMU) and the year 2000 (CH) were
analyzed by Kaplan-Meier survival curve. The patients who lost to follow up and could not be contacted were
censored at the time of last clinic visit. Log-Rank test was used to compare the survival curve and waiting time
between three hospitals.
Results : The averaged annual referrals for cardiac surgery at the three hospitals were 846 cases (205 for
Chula, 462 for CH and 179 for CMU). Mean age was 4.3±4.2 years and 51% were male. Follow up data were
complete in 96.3%. Surgical procedures were correction of simple shunt lesions (ASD, VSD, AV canal) in
33.9%, close heart surgery (PDA ligation, coarctation repair, BT shunt) in 29.9%, total repair TOF in 19.6%,
complex surgery in neonate and infants (arterial switch, TAPVR repair, Norwood procedure, truncus and
interrupted aortic arch repair) in 4.2% and others in 12.3%. Median waiting time was 195 days and was
significantly different between the three hospitals (p < 0.01). Mortality while waiting were approximately 5%
at 2 years at Chula and CH, which was significantly higher than CMU (0%, p = 0.02). Further analysis
revealed difference in age (lower Chula than CH than CMU) and types of surgery (more complex at Chula and
CH) which may be the causes for difference in the mortality observed.
Conclusion : Waiting time for cardiac surgery for children in Thailand is long and should be viewed as a
problem in public health policy. Optimal waiting time at each hospital may not have to be the same, depending
on the type and severity of the disease seen at each particular center. Attempt should be made to solve this
problem at the national level.
Keywords : Heart surgery, Congenital heart disease, Children, Mortality, Waiting time, Health service
