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Published on: July 18, 2014
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.
Insights
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.
Abstract:
Introduction: The absence of a congenital heart surgery national registry limits understanding of access, surgical volume, and mortality. This study analyzes the Brazilian administrative data to assess procedural distribution, outcomes, and regional disparities in congenital heart surgery. Methods: Retrospective analysis of the National Database (SIH/SUS) via DATASUS from January 2019 to December 2023. Ten benchmark congenital heart disease (CHD) surgeries were included. Admissions, in-hospital deaths, and mortality rates were extracted and stratified by region (North, Northeast, South, Southeast, and Center-West). Data were indexed per 100,000 live births using SINASC. Mann-Whitney and Fisher's exact tests were applied (P-value < .05). Results: Of 9509 operations, the Southeast region performed 3661 (38.5%), followed by the South region (2261; 23.8%), then the Northeast (2.087; 22%), the Center-West (893; 9.4%), and the North region (607; 6.4%). Overall, in-hospital mortality was 6.4% (609/9509), with significant variation: 11.7% (105/893) in the Center-West and 11.2% (68/607) in the North versus 4.1% (86/2087) in the Northeast (P-value < .0001). Mortality reached 24.6% (79/321) for transposition of the great arteries, 32.9% (24/73) for truncus arteriosus, and 60.4% 125/207) for the Norwood operation. Indexed by live births, the South performed up to 3 times more surgeries than the North. Conclusion: DATASUS National administrative data reveal significant disparities in access and outcomes for CHD surgery in Brazil, with mortality well above international benchmarks. Findings underscore the urgent need for investment in infrastructure, specialized workforce training, and creation of a national registry to improve equity and quality of care for children with CHDs.
