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Sex differences in mortality in children undergoing congenital heart disease surgery: a United States
Ariane Marelli1, Kimberlee Gauvreau, Mike Landzberg
1McGill Adult Unit for Congenital Heart Disease, McGill University Health Centre, Montreal, Quebec, Canada. ariane.marelli@mcgill.ca
Insights
Male children are more likely to undergo congenital heart disease (CHD) surgery. However, female infants undergoing high-risk CHD surgeries face a higher mortality risk.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Research
- Surgical Outcomes
Background:
- Adult congenital heart disease (CHD) population demographics are shifting.
- Understanding factors influencing survival to adulthood is crucial.
- Investigating sex differences in pediatric CHD surgical mortality is needed.
Purpose of the Study:
- To investigate sex differences in pediatric congenital heart disease (CHD) surgical mortality.
- To identify demographic and procedural factors associated with CHD surgical outcomes in children.
Main Methods:
- Utilized the Kids' Inpatient Database (2000, 2003, 2006) for CHD surgeries in children (<18 years).
- Employed Risk Adjustment for Congenital Heart Surgery (RACHS-1) for variable grouping.
- Conducted logistic regression to assess the odds of death in females versus males, adjusting for key variables.
Main Results:
- Males constituted 54.7% of 33,848 CHD surgeries; they were more likely to have early and high-risk procedures.
- Females had more noncardiac anomalies and low-risk procedures.
- Overall adjusted in-hospital death risk was higher in females (OR, 1.21), primarily driven by infants (<1 year) undergoing high-risk surgeries (OR, 1.39).
Conclusions:
- Male children underwent more CHD surgeries, including high-risk ones.
- Female infants with high-risk CHD procedures showed increased mortality risk.
- This specific subgroup's impact on overall adult CHD demographics is likely minimal.
Background:
The changing demographics of the adult congenital heart disease (CHD) population requires an understanding of the factors that impact patient survival to adulthood. We sought to investigate sex differences in CHD surgical mortality in children.
Methods And Results:
Children <18 years old hospitalized for CHD surgery were identified using the Kids' Inpatient Database in 2000, 2003, and 2006. Demographic, diagnostic, and procedural variables were grouped according to RACHS-1 (Risk Adjustment for Congenital Heart Surgery) method. Logistic regression was used to determine the odds ratio of death in females versus males adjusting for RACHS-1 risk category, age, prematurity, major noncardiac anomalies, and multiple procedures. Analyses were stratified by RACHS-1 risk categories and age. Of 33 848 hospitalizations for CHD surgery, 54.7% were in males. Males were more likely than females to have CHD surgery in infancy, high-risk CHD surgery, and multiple CHD procedures. Females had more major noncardiac structural anomalies and more low-risk procedures. However, the adjusted risk of in-hospital death was higher in females (odds ratio, 1.21; 95% confidence interval, 1.08 to 1.36) on account of the subgroup with high-risk surgeries who were <1 year of age (odds ratio, 1.39; 95% confidence interval, 1.16 to 1.67).
Conclusions:
In this large US population study, more male children underwent CHD surgery and had high-risk procedures. Female infants who had high-risk procedures were at higher risk for death, but this accounted for a small proportion of females and is therefore unlikely to have a major impact on the changing demographics in adults in CHD.
