Comparison Over Two Eras of Perioperative Adverse Outcomes in Children With and Without Congenital Heart Disease Undergoing Noncardiac Surgery

Despite advances in medical care, noncardiac surgery in children with congenital heart disease (CHD) remains associated with considerable perioperative morbidity and mortality. This study evaluates trends in postoperative outcomes after noncardiac surgery in children with and without CHD across two time periods. We aimed to determine and compare the incidence of adverse outcomes following noncardiac surgery in a large cohort of children without CHD, in children with minor CHD, major CHD, and severe CHD, across two time periods (2012-2016 and 2017-2022, excluding 2020). Children undergoing noncardiac surgery from 2012 to 2022 were identified from the ACS-NSQIP Pediatric database, excluding 2020. Patients were stratified by CHD severity (none, minor, major, severe) and by era (2012-2016 vs. 2017-2022). Outcomes included 30-day mortality, cardiac arrest, reintubation, reoperation, and readmission. Multivariable logistic regression was used to compare outcomes across eras, adjusting for demographic, clinical, and procedural variables. Among 1 023 638 children, there were 88.3% patients with no CHD and 11.7% with CHD (5.9% minor, 5.2% major, 0.6% severe). Improvements were seen across all CHD subgroups, particularly in reintubation and readmission rates. The most consistent improvement was in reintubation, including in severe CHD (aOR 0.69; 95% CI: 0.53, 0.89; p = 0.005). These findings demonstrate meaningful improvements in postoperative outcomes over time, notably reduced rates of 30-day mortality, reintubation, and readmission in the non-CHD group. Patients with minor and major CHD experienced significant declines in reintubation and readmission, while those with severe CHD showed reduced reintubation. Despite rising CHD prevalence and complexity, improvements likely reflect advances in perioperative care, risk stratification, and multidisciplinary management at specialized centers for children undergoing noncardiac surgery.