Key result
Systematic review protocol evaluates perioperative risk factors for mortality and complications in pediatric heart surgery.
Why the study?
Advances in paediatric congenital heart disease care remain unavailable to over 90% of affected children in low- and middle-income countries, where evidence on risk factors for postoperative in-hospital mortality and major complications remains limited.
What patient, surgical, anaesthetic, and perioperative risk factors are associated with in-hospital all-cause mortality and major postoperative complications in paediatric patients undergoing congenital cardiac surgery, and how do these differ between low-/middle-income and high-income countries?
Systematic Review
What patient, surgical, anaesthetic, and perioperative risk factors are associated with in-hospital all-cause mortality and major postoperative complications in paediatric patients undergoing congenital cardiac surgery, and how do these differ between low-/middle-income and high-income countries?
This systematic review protocol establishes a standardized methodology to identify and compare perioperative risk factors for in-hospital mortality and major complications after paediatric congenital cardiac surgery across low-, middle-, and high-income countries.
Answers are grounded in this paper and cite their sources.
Protocol outlines standardized assessment of paediatric congenital heart surgery risks; leaves open pooled estimates and LMIC-HIC comparisons pending 2026 completion.
Background Approximately 70% of patients born with congenital heart disease (CHD) require medical or surgical treatment in their first year of life. A reported 90–95% will survive to adulthood due to advances in paediatric cardiology, cardiac surgery and anaesthesia. These reported advances are still not available for over 90% of the children born with CHD in low-and middle-income countries (LMIC). The objectives of this study are to determine the pooled incidence of in-hospital all-cause mortality; identify risk factors associated with in-hospital all-cause mortality and a composite of major complications in paediatric patients undergoing congenital cardiac surgery; and to compare these risk factors between LMICs and high-income countries (HICs). Methods A systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; this has been registered with PROSPERO 2024 (CRD42024618297). The Population, Exposure and Outcome (PEO) framework will guide the search strategy. Eligible studies will include prospective and retrospective cohort studies, case-control studies, interventional studies and registry/database studies reporting risk factors for in-hospital all-cause mortality and/or major postoperative complications in paediatric patients (≤18 years) undergoing cardiac surgery for CHD. A comprehensive electronic search of PubMed, Scopus, CINAHL, Cochrane Library and Web of Science will identify peer-reviewed English-language studies published from January 2000–2026. Two reviewers will independently screen studies, extract data using a standardised data extraction form, and assess risk of bias using the Newcastle-Ottawa Scale or ROBINS-I, as appropriate to study design. Where appropriate, we will perform random-effects meta-analysis to estimate pooled effect measures and 95% confidence intervals. Statistical heterogeneity will be assessed using the I² statistic, and results will otherwise be synthesised narratively. Where sufficient data are available, risk factors will be compared between LMICs and HICs. Discussion In-hospital mortality and major complications following paediatric congenital cardiac surgery are associated with a combination of patient-, surgical- and perioperative risk factors. Identifying these facilitates early risk stratification and optimisation of modifiable risk factors to support targeted perioperative interventions and resource allocation, particularly in LMICs where evidence remains limited. A meta-analysis is not anticipated because of substantial heterogeneity in the study population.
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Mogane et al. (2026) conducted a systematic review in Congenital heart disease undergoing paediatric cardiac surgery. Patient-, disease-, surgical-, anaesthetic-, and perioperative risk factors in paediatric congenital cardiac surgery vs. Absence of risk factors or comparison between low- and middle-income countries (LMICs) and high-income countries (HICs) was evaluated on In-hospital all-cause mortality and a composite of major postoperative complications (cardiac arrest, low cardiac output syndrome, need for extracorporeal life support, prolonged pleural effusion, emergency reoperation and/or major haemorrhage requiring surgical re-exploration, multiorgan failure requiring support such as acute renal failure, atrioventricular block requiring a permanent pacemaker, and new-onset persistent neurological dysfunction at discharge). Patient-, surgical-, and perioperative risk factors for in-hospital mortality and major complications after paediatric congenital heart surgery will be evaluated in this registered systematic review protocol (CRD42024618297).
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