Pediatric cardiac surgery in Sudan before the 2023 armed conflict: patterns, outcomes, and quality indicators from a single-center experience in a low-resource setting.

BACKGROUND

Sudan's pediatric cardiac surgery services improved over the past decade, especially after the 2022 national free program. However, conflict in April 2023 halted all services. There is a scarcity of scholarly literature concerning pediatric cardiac surgery in low-income African countries such as Sudan. This study documents the achievements made before the conflict.

METHODS

This was a prospective observational study conducted at the Sudan Heart Center. Data were collected from hospital medical records between January and December 2022. All patients who underwent surgical intervention during that period were included, while those who did not undergo surgery were excluded. Standardized Quality Performance Indicators (QPIs) were applied to evaluate outcomes. The primary outcome was overall mortality. The secondary outcome included ICU stay, hospital stay, and postoperative complication rates.

RESULTS

A total of 229 patients underwent pediatric cardiac surgery, with males representing 57.2%. The median age; 3 years (IQR 0-6) and the median weight; 12 kg (IQR 7-17.5). Ventricular septal defect repair 25% and tetralogy of Fallot repair 21.8% were the most common operations, complex surgeries such as Fontan, Rastelli, and arterial switch surgeries were also performed. The measured mortality rate was 12.2%, the median ICU stay; 3 days (IQR 1-5) and hospital stay; 7 days (IQR 5-11). Observed complications included central line-associated bloodstream infection 7.4%, surgical site infection 2.6%, urinary tract infection 1.7% and ventilator-associated pneumonia 0.9%. Peritoneal dialysis was used in 5.2% of patients, and neurological complications occurred in 4.8%. Diaphragmatic paralysis and chylothorax were observed in 1.3% and 1.7% of patients, respectively. No patient required permanent pacemaker (PPM) implantation.

CONCLUSION

Sudan's pediatric cardiac surgical services, though limited in resources, had developed to a level similar to that of other low-income African countries. The 2023 armed conflict has likely erased these gains by shutting down all cardiac services. To restore and sustain such programs, international long-term support is required in crisis-affected regions.