Postoperative complications after paediatric cardiac surgery: the role of ethnicity and deprivation – a national cohort study

TL;DR

This study found that children from more deprived areas face higher risks of certain post-surgery complications after pediatric heart surgery.

Contribution

The study identifies socioeconomic deprivation as a factor linked to increased postoperative complications in pediatric cardiac surgery.

Findings

Children from deprived areas had higher odds of prolonged pleural effusion and extracorporeal life support.

Ethnicity influenced the types of congenital heart conditions and risk factors present in patients.

Adjusting for case complexity revealed disparities in postoperative outcomes linked to deprivation.

Abstract

To understand whether the risk of complications following paediatric cardiac surgery differs according to a child’s ethnicity or the degree of residential deprivation.

We conducted a retrospective cohort study using data from the National Congenital Heart Disease Audit, including children younger than 18 years who underwent cardiac surgery between April 2015 and March 2022 across 10 paediatric cardiac surgical centres in England and Wales. We examined the occurrence of six defined postoperative complications and used previously reported descriptive models to account for case complexity. Multivariable analysis was used to assess the association between complications and individual ethnicity and socioeconomic deprivation.

There were 23 423 30-day postoperative episodes. Children of Asian ethnicity were more likely to have a functionally univentricular heart or congenital cardiac risk factors, while children of Black ethnicity were more likely to have Down syndrome and prematurity than children of the remaining ethnicities. Children from the most versus the least deprived areas had higher rates of congenital comorbidity, functionally univentricular heart, high illness severity and urgent operations. After adjusting for case complexity, children from high compared with low deprivation areas had greater odds of prolonged pleural effusion (p=0.05), extracorporeal life support (p=0.001) and unplanned reintervention within 30 days (p=0.04).

Greater area deprivation in England is associated with increased preoperative medical complexity and a higher incidence of certain postoperative complications among children with congenital heart disease (CHD). Further research is needed to explore the relationship between ethnic background and perioperative outcomes in CHD and to develop pathways to improvement based on social factors.

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