Article Text

Download PDFPDF
Original research article
Impact of International Quality Improvement Collaborative on Congenital Heart Surgery in Pakistan
  1. Amina Khan1,
  2. Ahmed Abdullah2,
  3. Huzaifa Ahmad2,
  4. Arjumand Rizvi3,
  5. Sehrish Batool4,
  6. Kathy J Jenkins5,
  7. Kimberlee Gauvreau5,
  8. Muneer Amanullah6,
  9. Anwar Haq6,
  10. Nadeem Aslam1,
  11. Fauzia Minai7,
  12. Babar Hasan3
  1. 1 Pediatric Cardiac Intensive Care Unit, Aga Khan University, Karachi, Pakistan
  2. 2 Aga Khan University Medical College, Karachi, Pakistan
  3. 3 Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
  4. 4 Karachi Medical and Dental College, Karachi, Pakistan
  5. 5 Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
  6. 6 Department of Surgery, The Aga Khan University, Karachi, Pakistan
  7. 7 Department of Anesthesiology, The Aga Khan University, Karachi, Pakistan
  1. Correspondence to Huzaifa Ahmad, Medical College, Aga Khan University, Karachi 74800, Sindh, Pakistan; huzaifaja{at} and Dr Babar Hasan, Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Sindh, Pakistan; babar.hasan{at}


Background The International Quality Improvement Collaborative (IQIC) was formed to reduce mortality and morbidity from congenital heart disease (CHD) surgeries in low/middle-income countries.

Objectives We conducted this study to compare the postoperative outcomes of CHD surgeries at a centre in Pakistan before and after joining IQIC.

Methods The IQIC provides guidelines targeting key drivers responsible for morbidity and mortality in postoperativepatients with CHD. We focused primarily on nurse empowerment and improving the infection control strategies at our centre. Patients with CHD who underwent surgery at this site during the period 2011–2012 (pre-IQIC) were comparedwith those getting surgery in 2013–2014 (post-IQIC). Morbidity (major infections), mortality and factors associated with them were assessed.

Results There was a significant decrease in surgical site infections and bacterial sepsis in the post-IQIC versus pre-IQIC period (1% vs 30%, p=0.0001, respectively). A statistically insignificant decrease in the mortality rate was also noted in post-IQIC versus pre-IQIC period (6% vs 9%, p=0.17, respectively). Durations of ventilation and intensive care unit (ICU) and hospital stay were significantly reduced in the post-IQIC period. Age <1 year, malnutrition, low preoperative oxygen perfusion, Risk Adjustment for Congenital Heart Surgery score >3, major chromosomal anomalies, perfusion-related event, longer ventilation and ICU/hospital stay durations were associated with greater odds of morbidity and mortality.

Conclusion Enrolling in the IQIC programme was associated with an improvement in the postsurgical outcomes of the CHD surgeries at our centre.

  • congenital heart disease
  • surgical outcomes
  • developing country
  • quality improvement

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors AK, BH and AA have contributed equally to the study concept, designing, data collection, analysis and manuscript writing. HA contributed to the data collection, analysis, manuscript writing and revision. KG, AR and SB contributed to the data analysis and manuscript writing. KJJ contributed to the study concept, design, analysis and manuscript writing. MA, AH and FM contributed to the conception, study design, patient selection, manuscript editing and final approval of the study. NA contributed to the data entry, data validation, concept, patient selection and manuscript editing.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles