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Several doctors confirm that there is a waiting period of at least two months for patients requiring cardiothoracic surgeries (not emergencies), including CABG. | Photo Credit: Getty Images/iStockphoto
Fewer full-fledged centres and fewer hands have led to a higher caseload of patients requiring cardiac surgeries and longer waiting time in some of the major government hospitals in the State.
The Departments of Cardiothoracic Surgery of Rajiv Gandhi Government General Hospital and Tamil Nadu Government Multi Super Speciality Hospital in Chennai and Government Rajaji Hospital (GRH) in Madurai see a high volume of patients for surgeries, including Coronary Artery Bypass Grafting (CABG) and valve surgeries. Both the Coimbatore and Tirunelveli government medical college hospitals do not perform cardiac surgeries in a full-fledged manner, a cross-section of doctors said. The Institute of Child Health and Hospital for Children, Egmore is the major centre for paediatric cardiothoracic surgeries in the State.
A recent review document that looks at the performance of government medical colleges (excluding RGGGH) put the institutions in Madurai, Coimbatore and Tirunelveli as the top three, while the Government Mohan Kumaramangalam Medical College Hospital, Salem, Government Stanley Medical College Hospital and Government Kilpauk Medical College Hospital in Chennai fell behind in key cardiothoracic surgeries, such as open and closed valvular surgeries and CABG, among a specific category of hospitals. Several government medical college hospitals, such as in Tiruchi, do not have the required manpower, official sources added.
Several doctors confirmed that there was a waiting period of at least two months for patients requiring cardiothoracic surgeries (not emergencies), including CABG. “There is a backlog of cases. Though we can advise patients with valvular diseases, it is difficult to ask those requiring CABG to wait,” a senior doctor said.
“The maximum number of cardiothoracic surgeries are done by very few institutions as a result of which the waiting list is at least two months now. This has to be streamlined,” another government doctor added. A super speciality student noted that a centre like GRH received patients from various districts including Dindigul, Sivaganga and Ramanathapuram.
More than one factor is at play. First, with very few government hospitals performing surgeries full-fledged, the movement of patients is mostly towards Chennai and Madurai. Secondly, the number of surgeries that can be performed in a day is less as cardiothoracic surgeries take a longer time and depend on the number of surgeons/teams/trained technicians/operating tables in place. Lastly, over the years, the uptake for super speciality courses (MCh) in cardiovascular and thoracic surgery has been low due to reasons including low remuneration, a cross-section of government doctors said. Only this year have more candidates joined the course, they pointed out.
“There needs to be a separate team, including anaesthetists specifically for cardiothoracic surgery. In cardiac centres, post-operative management will be taken up by trained anaesthetists. We need perfusionists. One surgery takes at least five to seven hours and so, a maximum of three surgeries can be performed in a day. It also depends on the number of operating tables in a hospital,” the doctor said.
Senior doctors pinpointed the low uptake for the MCh course over the years. “A long period of training, time taken to establish practice and poor remuneration in the government sector has deterred many, as a result of which seats were left vacant in the past years.” The State government has not created posts of cardiothoracic surgeons in peripheral institutions and there was attrition among surgeons as well, another doctor added on condition of anonymity. The situation would improve only if more centres start performing surgeries and the manpower crunch is addressed, doctors said.
An official of the Directorate of Medical Education and Research said that medical college hospitals with departments of Cardiothoracic Surgery were told to improve their performance. “Cardiothoracic surgeons too are fewer in number as many move to the private sector. We are planning to hold a walk-in interview,” he said.
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