Sex Differences in Congenital Heart Surgery in Low and Middle Income Countries

BackgroundCongenital heart diseases (CHD) are the most common birth defect. Previous studies found sex disparities in outcomes after cardiac surgery and in access to treatment, but little data is available for low- and middle-income countries (LMIC).MethodsData on CHD surgical admissions in children <18 years of age from 70 sites in 25 LMIC for cases between 2011 and 2020 from the International Quality Improvement Collaborative for Congenital Heart Disease (IQIC) were analyzed to explore whether risk-adjusted in-hospital mortality and major infections differed by sex overall and for six common CHD surgeries. The difference between the percentage of males and females operated on for these CHDs was compared between the IQIC and in the United States (KID 2012).FindingsOf 108,439 surgical admissions, 54.4% (59,021/108,439) were males. After adjusting for case mix, no statistically significant differences in odds ratios for mortality or infection by sex were found, although females had a lower risk of death in lower complexity and higher risk of infection in higher complexity surgeries. Six lesions analysis revealed higher odds of mortality in females for ventricular septal defect repair and higher risk of major infection for coarctation repair and the arterial switch operation compared with males. For 5 of the 6 lesions, fewer females underwent surgery in IQIC compared with the United States.InterpretationOur findings suggest that female children in LMIC have unequal access to CHD surgery compared with males with few postoperative differences in mortality or infection. Cultural and socio-economic factors such as access to timely diagnosis may be contributory.