Characteristics and risk factors for postoperative mortality in children with congenital heart disease (CHD): a retrospective cross-sectional study

Objectives: We performed a retrospective cross-sectional study to determine the characteristics and risk factors for postoperative mortality in children who underwent CHD surgery. Design: A cross-sectional retrospective study. Setting: Guangdong Provincial People’s Hospital from January 1, 2005, to December 31, 2020. Patients: All pediatric patients who underwent open heart surgery for CHD. Interventions: None. Measurements and Main Results: Patients’ demographic features, clinical data, preoperative comorbidities and postoperative complications, and outcomes were collected. The in-hospital mortality rate was computed, and the relationship with independent variables was determined. Univariate and multivariate logistic regression analyses were used to determine risk factors for in-hospital mortality in children with CHD surgery. A total of 23,366 children with CHD were included in the analysis, of whom 502 patients (2.15%) died after CHD surgery. Complex mixed defect CHD, neonatal period and male sex were the CHD type, age group and sex with the highest in-hospital mortality of 4.56%, 11.85% and 2.55%, respectively. Male (OR=1.31; 95% CI 1.04 to 1.65; p=0.006), infant period (OR=0.55; 95% CI 0.42 to 0.71; p<0.001), toddler age (OR=0.37; 95% CI 0.25 to 0.56; p<0.001), preschool age (OR=0.31; 95% CI 0.19 to 0.50; p<0.001), school age and adolescence (OR=0.37; 95% CI 0.23 to 0.61; p<0.001), left obstructive lesion CHD (OR=2.13; 95% CI 1.43 to 3.17; p=0.014), right to left shunt CHD (OR=3.21; 95% CI 2.39 to 4.30; p<0.001), complex mixed defect CHD (OR=2.34; 95% CI 1.80 to 3.06; p<0.001), critical case at admission (OR=2.44; 95% CI 1.90 to 3.12; p<0.001), number of rescues, postoperative infection and respiratory failure were independently associated with in-hospital mortality. Conclusions: : The younger the age and the more complicated the cyanotic heart disease, the higher the mortality rate, especially for boys. A critical condition at admission and postoperative infection especially in the respiratory system, increased in-hospital mortality. Further studies are needed paying more attention to preoperative condition maintenance and postoperative complication control.