Open Access

ARTICLE

Predictors of In-Hospital Mortality and Survival Outcomes in a Paediatric Congenital Cardiac Cohort in South Africa—A 12-Year Review

Prathap Sarma¹, Palesa Mogane^2,*, Katharina Vanderdonck³, Moses Kebalepile¹, Palesa Motshabi Chakane⁴

1 Department of Anaesthesiology, University of the Witwatersrand, Johannesburg, 2193, South Africa
2 Department of Anaesthesiology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, 2193, South Africa
3 Department of Cardiothoracic Surgery, Nelson Mandela Children’s Hospital, University of the Witwatersrand, Johannesburg, 2193, South Africa
4 Department of Anaesthesiology, Charlotte Maxeke Johannesburg General Academic Hospital, University of the Witwatersrand, Johannesburg, 2193, South Africa

* Corresponding Author: Palesa Mogane. Email:

Congenital Heart Disease 2025, 20(1), 41-53. https://doi.org/10.32604/chd.2025.060382

Received 30 October 2024; Accepted 24 February 2025; Issue published 18 March 2025

Abstract

Background: Congenital cardiac diseases (CCD) are common congenital birth defects that require high-risk surgery. Outcomes following congenital cardiac surgery in children living in high-income countries (HIC) have been documented, but little is known from the African continent. This study aimed to determine factors associated with perioperative mortality in patients who underwent congenital cardiac surgery at our institution. Methods: This retrospective, cross-sectional study was conducted at Charlotte Maxeke Johannesburg Academic Hospital over 12 years (2006–2017). A multivariable regression analysis was performed for the factors which had a p-value of 0.1 and less in the univariable regression analysis. A Cox regression analysis was performed for mortality over time. All hypothesis testing accepted a p-value of <0.05 as statistically significant. Results: There was an 11% (188/1701) in-hospital mortality rate overall. Patients who had a median age of 0.33 years (interquartile range [IQR] 0.13–1.25), weight of 5 kg (IQR 3.45–8.20), longer cardiopulmonary bypass (CPB) of 179 min (16.0–275.5) and aortic cross-clamp of 82.5 min (35–139) were at greater risk of in-hospital mortality. Palliative surgeries had the highest in-hospital mortality rate at 41%. Cardiopulmonary bypass time (p < 0.001), ICU length of stay (p < 0.001), aortic cross-clamp time (p = 0.001) and days on the ventilator (p < 0.001) were independently predictive of perioperative all-cause in-hospital mortality in a multivariable regression model. Current predictive scoring systems had inconsistent performance, with the STAT 2020 mortality score being predictive in a multivariable regression analysis (p = 0.038) and the RACHS-2 score in a Cox regression analysis (p = 0.002). Conclusions: Perioperative mortality following congenital cardiac surgery was higher in our study group compared to HICs. Future prospective studies are required to highlight the need to prioritise and invest in the declining services provided to children with CCD in South Africa’s public sector.

---

Keywords

---

Supplementary Material

Supplementary Material File

---