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South African Medical Journal

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Is cardiac surgery warranted in children with Down syndrome? A case-controlled review

MA Roussot, JB Lawrenson, J Hewitson, R Smart, HP de Decker

Abstract


Objectives. To compare children with Down syndrome and children without  Down syndrome and investigate whether there is a significant difference in  the burden that is placed on the health care system between these two  groups only in respect of the repair of congenital heart disease at Red  Cross War Memorial Children's Hospital, Cape Town, South Africa.

Design. This study is a retrospective case control review.

Setting. Red Cross War Memorial Children's Hospital, Cape Town, South  Africa.


Subjects. The sample group of 50 Down syndrome children who had  received cardiac surgery between January 1998 and June 2003 was  compared with a control group of 50 nonsyndromic children who had  received cardiac surgery during the same period.


Outcome measures. Sex and diagnoses (cardiac and noncardiac), number of days spent in hospital and in ICU, complication rates, re-operation  rates, early mortality rates, planned further cardiac surgery. Costs of these outcomes were not quantified in exact monetary terms.

 
Results. There was no significant difference between the two groups in  terms of the burden that was placed on the health care system. Similar  complication rates, re-operation rates and early mortality rates were  recorded for both groups. The Down syndrome group appeared to benefit more from cardiac surgery than the non-Down syndrome group.


Conclusion. Denying cardiac surgery to children with Down syndrome does not improve the efficiency of resource allocation. It is therefore not  reasonable to suggest that the .problem of scarce resources can be ameliorated by discriminating against children with Down syndrome.




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