Surgical Treatment of Palestinian Patients with Congenital Heart Disease in a Medical Center in Israel: Challenges and Outcome

Background: The treatment of congenital heart disease patients in the West Bank and Gaza involves both medical and political challenges. To better understand these challenges' effects on Palestinian patients, we compared surgical results between Israeli and Palestinian patients. Understanding the difficulties faced in treating the Palestinian population is an important step to improving surgical care, better allocating resources and overcoming the region's unique problems. Methods: We retrospectively reviewed the Hadassah Medical Center congenital heart disease database. Between January 2011 and December 2017, there were 872 operations performed in patients with Israeli health insurance and 207 operations in Palestinian patients.  Demographics, clinical characteristics, surgical complexities, time to treatment, PICU length of stay, hospital length of stay, mortality and follow-up rates were compared between the two groups using standard statistical practices. Findings: The surgical complexity was significantly higher in the Palestinian patient population (p=0.003) and there were relatively more Palestinian patients with single ventricle anatomy (25.6%, 53/207) than Israeli patients (19.8%, 172/872) p=0.067. Israeli neonates had surgery at an average age of 9.5±7.8 days as compared to Palestinian neonates with an average age of 15.7±8.2 days, p<0.001, a finding indicative of a possible delay in diagnosis or treatment. Overall in hospital mortality was not significantly different. Late mortality was significantly different between the groups, 2% (14/698) for the Israeli and 5.4% (9/168) for the Palestinian patients (p=0.015). Interpretation: The findings suggest that Palestinian patients receive later treatment and poorer follow-up care than Israeli patients. Despite the political challenges in the region surgical results are excellent and comparable between the two groups. The challenges described are not unique to congenital heart disease and may affect many medical fields. We believe that extensive collaborations between Israeli and Palestinian physicians may be key to improving medical care in the West Bank and Gaza. Funding: None. Declaration of Interest: The authors have nothing to disclose. Ethical Approval: The Hadassah Medical Center Institutional Review Board approved the study and waived individual patient consent due to the retrospective nature of the study.