Paediatric Cardiac Surgeries: A 15-Year Retrospective Study at Komfo Anokye Teaching Hospital, Ghana

Background: Congenital heart disease (CHD) is a major cause of infant mortality, with an incidence of 9.41 per 1,000 live births. In Africa, limited healthcare infrastructure makes CHD management particularly challenging. Over the past 15 years, Komfo Anokye Teaching Hospital (KATH), Kumasi, has developed a paediatric open-heart surgery program. Aim: The primary aim was to characterise paediatric cardiac surgeries over a 15-year period and compare anaesthesia protocols before and after 2014. The secondary aim was to evaluate the impact of protocol changes introduced in 2014, including implementation of the WHO surgical safety checklist, adoption of early extubation, use of tranexamic acid, modified glycaemic control, and rationalised inotrope therapy. Materials and Methods: This single-centre, retrospective census-sampling review included 137 paediatric cardiac surgeries performed between October 2007 and September 2022. Patients were divided into Group A (before 2014) and Group B (after 2014). Institutional ethical approval was obtained, and data were analysed using SPSS version 23.0. Results: Compared with Group A, Group B demonstrated improved outcomes, including higher rates of ultra-fast track extubation (7.84 vs. 37.31; P 0.014), shorter ventilation times (82.34 11.70 vs. 22.73 6.49 hours; P 0.028), reduced adrenaline (56.72 10.46 vs. 17.36 4.64 hours; z 2.156) and dopamine use (13.26 6.57 vs. 6.73 2.38 hours; z 1.977), lower postoperative chest drainage (133 28.46 vs. 97 15.83 ml; P 0.036), fewer re-explorations for haemorrhage (11.77 vs. 1.21; P 0.018), and shorter mean hospital stay (6.87 3.51 vs. 4.18 3.52 days; P 0.047). More patients required no inotropes in Group B (22.89 vs. 9.81; P 0.026). Conclusions: Systematic protocol changes after 2014 significantly improved perioperative outcomes despite resource limitations. These findings demonstrate the value of adapting the best global practices to local contexts in low- and middle-income countries.