Associations With Adverse Postoperative Outcomes in Children Undergoing Atrial Septal Defect Closure in Lower-Resource Settings.

Background: Atrial septal defects (ASDs) are a common cause of congenital heart disease worldwide.

Objectives: The purpose of the study was to assess change over time in surgical outcomes for ASD repair and identify patient-level risk factors for adverse postoperative outcomes.

Methods: We analyzed cases of isolated ASD in patients <18 years from 2010 to 2020 from 71 sites participating in the International Quality Improvement Collaborative for Congenital Heart Disease. Regression models identified associations between patient characteristics and 3 outcome variables: in-hospital death, major infection, and intensive care unit (ICU) length of stay (LOS).

Results: Among 9,127 ASD closures, 7,653 (84%) were ASD secundum. A total of 914 patients (10%) had ASD repair at <1 year. A total of 3,363 (38%) were <5% for World Health Organization weight/body mass index for age percentile. A total of 2,511 surgeries (28%) occurred from 2010 to 2014 and 6,616 (72%) from 2015 to 2020. Overall, in-hospital mortality was 0.45% and major infection was 0.65%. Median ICU LOS was 27 hours. Prematurity (odds ratio [OR]: 9.62;  = 0.006), oxygen saturation <90% (OR: 5.89;  = 0.004), and year of surgery 2010 to 2014 (OR: 5.18;  < 0.001) were associated with in-hospital mortality. Age <1 year (OR: 2.24;  = 0.008), noncardiac anomaly (OR: 4.67;  < 0.001), chromosomal abnormality (OR: 2.54;  = 0.029), preoperative intervention (OR: 4.67;  = 0.008), low World Health Organization weight/body mass index for age <5% (OR: 2.36;  = 0.019), and year of surgery 2010 to 2014 (OR: 2.40;  = 0.011) were associated with infection. ICU LOS did not change between the 2 time periods, adjusting for other factors.

Conclusions: 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.