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Regional Variation in Congenital Heart Surgery in Brazil: A National Database Analysis
Leonardo A Miana1, Jeffrey P Jacobs2, Juan P U Passos3
1Pediatric and Congenital Heart Surgery Unit - Incor - HC- FMUSP, São Paulo, SP, Brazil.
World Journal for Pediatric & Congenital Heart Surgery
|February 28, 2026
Summary
Brazilian congenital heart surgery data show significant regional disparities in access and outcomes, with mortality rates exceeding international benchmarks. Urgent investment is needed to improve care for children with congenital heart disease (CHD).
Area of Science:
- Cardiovascular Surgery
- Public Health
- Health Services Research
Background:
- Lack of a national registry for congenital heart surgery hinders understanding of access, surgical volume, and mortality in Brazil.
- Existing administrative data offer a potential resource for analyzing procedural distribution and outcomes.
Purpose of the Study:
- To analyze Brazilian administrative data to assess the distribution, outcomes, and regional disparities of congenital heart surgery.
- To identify areas needing improvement in the care of children with congenital heart disease (CHD).
Main Methods:
- Retrospective analysis of the National Database (SIH/SUS) via DATASUS (January 2019 - December 2023).
- Included ten benchmark congenital heart disease (CHD) surgeries, extracting admissions, in-hospital deaths, and mortality rates.
- Data stratified by region and indexed per 100,000 live births; statistical tests included Mann-Whitney and Fisher's exact tests.
Main Results:
- The Southeast region performed the most surgeries (38.5%), while the North performed the fewest (6.4%).
- Overall in-hospital mortality was 6.4%, with significant regional variation (North: 11.2%, Center-West: 11.7%, Northeast: 4.1%).
- Specific complex procedures like the Norwood operation had mortality rates as high as 60.4%; surgical volume varied up to threefold between regions.
Conclusions:
- Brazilian administrative data reveal substantial disparities in access and outcomes for congenital heart surgery (CHD).
- Mortality rates are considerably higher than international benchmarks, highlighting critical care gaps.
- Urgent investment in infrastructure, workforce training, and a national registry is essential to improve equity and quality of care for children with CHDs.
