Quality improvement of perioperative outcome in cardiac interventions for children

Abstract

<strong>Introduction:</strong> Congenital heart defects are one of the most common congenital malformations. Although optimized surgical techniques and improved intensive care management have resulted in approximately 90 % of children reaching adulthood, pediatric cardiac surgery is associated with high complication rates. The aim of this dissertation was to improve the quality of the perioperative outcome in cardiac surgery in children.<br /> <strong>Methods:</strong> A total of four studies were conducted as part of this dissertation. The studies cover from a survey design, a retrospective, a prospective observational to a randomized controlled trial. All of them refer to the quality improvement of perioperative outcome parameters in cardiac surgery in children.<br /> <strong>Results:</strong> It could be shown in our survey study, that the overall approach of pre-anesthesia consultation in Europe is extremely varied, not at least because of varying legislation in the individual countries. Many anesthesiologists are uncertain about the legal situation; specifically for pediatric anesthesia, 67.3 % stated that purely digital information without face-to-face contact is not legal. Only 22.9 % considered online or telephone information to be legal, while 9.8 % could not assess the current legal situation. In the randomized trial, anesthesiologists and parents were significantly more satisfied with the quality of remote than with on-site pre-anesthesia consultation. The complications in our patient cohort occurred even less frequently in the remote group. Within our retrospective study, on-table extubation was shown to be safe and associated with a favorable postoperative course, including fewer catecholamine requirements and shorter duration of intensive care unit therapy. Furthermore, in our prospective observatory study, the use of ultrasound-guided central venous catheter insertion and tip positioning in children was shown to be a fast and reliable technique, preventing unnecessary x-ray exposure that may be considered for future policies.<br /> <strong>Conclusion:</strong> In various study designs, it could be shown, that the use of standardization such as digital informed consent and the use of new technologies in both the pre- and postoperative settings may improve the quality of perioperative outcome parameters in pediatric cardiac procedures.