Associations With Adverse Postoperative Outcomes in Children Undergoing Atrial Septal Defect Closure in Lower-Resource Settings
Authors' conclusion
High-quality surgical programs in low- and middle-income countries experienced an over 5-fold reduction in in-hospital mortality and an over 2-fold reduction of infection after ASD surgery over the past decade, with rates now comparable to some high-income settings, supporting equitable access to life-saving surgery.
Study context
- Population
- Patients <18 years undergoing isolated ASD closure in lower-resource settings (International Quality Improvement Collaborative for Congenital Heart Disease), 2010–2020
- Participants
- 9,127 ASD closures
- Exposure
- Patient characteristics and surgery period (2010–2014 vs 2015–2020) and adverse postoperative outcomes
- 2010–2014n = 2,511
- 2015–2020n = 6,616reference
- Outcome
- In-hospital death, major infection and ICU LOS
Methodological detailsmulticentre, 71 sites
- Multicentre
- 71 sites
Main finding
As reported in the abstract
In-hospital mortality, major infection, ICU LOS
- Prematurity · in-hospital mortality
- OR 9.62; P = 0.006
- Oxygen saturation <90% · in-hospital mortality
- OR 5.89; P = 0.004
- 2010–2014 vs 2015–2020 · in-hospital mortality
- OR 5.18; P < 0.001
- Age <1 year · infection
- OR 2.24; P = 0.008
- Noncardiac anomaly · infection
- OR 4.67; P < 0.001
- Chromosomal abnormality · infection
- OR 2.54; P = 0.029
- Preoperative intervention · infection
- OR 4.67; P = 0.008
- WHO weight/BMI for age <5% · infection
- OR 2.36; P = 0.019
- 2010–2014 vs 2015–2020 · infection
- OR 2.40; P = 0.011
- Overall in-hospital mortality
- 0.45%
- Overall major infection
- 0.65%
- Median ICU length of stay (LOS)
- 27 hours
Observational data: associations, not effects.
Original publication
Associations With Adverse Postoperative Outcomes in Children Undergoing Atrial Septal Defect Closure in Lower-Resource Settings. JACC Adv. Published 30 October 2024. doi:10.
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