5. Effect of protocol-based management for systemic to pulmonary shunt operations

Abstract

Clinical research. Presentation Type: Oral presentation. Introduction: Systemic to pulmonary shunt (commonly Modified Blalock-Tausing shunt – MBTS) is a palliative procedure in cyanotic heart diseases to overcome inadequate blood flow to the lung (1). Based on most recent risk stratification STAT score, the average mortality is still high (8.5%) in addition to significant post-operative morbidity especially in the neonatal and over-shunting patients. We developed and implemented protocoled management in March 2013 to better standardize the management of these patients. Aim of this study to evaluate the effect of applying this protocoled management in our center. Methodology: We conducted a retrospective Cohort study through chart review analysis of all children who underwent MBTS since year January 2000 till December 2015, We compared the early postoperative outcome of patients operated after the protocol management implementation (March 2013 till December 2015) (group A) with patients operated before implementing the MBTS protocoled management (group B). Results: 197 patients underwent MBTS since year 2000 till December 2015, 25 patients after the implementation the protocol management (group A), and 172 patients before the protocol implementation (group B). There was a significant improvement in the postoperative course and less morbidity after protocol management implementation as reflected in ventilation time, reintubation rate, inotropic support duration, and postoperative complications were all significantly lower in (group A). Mortality group A versus group B (15.7% VS 8%). Based on STAT score, the standardized mortality ratio (SMR) dropped from 1.84 before protocol implementation to 0.94 after protocol implementation. Conclusion: The study proves that protocol management of patients with MBTS can improve the postoperative course and early outcome.