Regional Variation in Congenital Heart Surgery in Brazil: A National Database Analysis

Abstract

Introduction: The absence of a congenital heart surgery national registry limits understanding of access, surgical volume, and mortality. This study analyzes the Brazilian administrative data to assess procedural distribution, outcomes, and regional disparities in congenital heart surgery. Methods: Retrospective analysis of the National Database (SIH/SUS) via DATASUS from January 2019 to December 2023. Ten benchmark congenital heart disease (CHD) surgeries were included. Admissions, in-hospital deaths, and mortality rates were extracted and stratified by region (North, Northeast, South, Southeast, and Center-West). Data were indexed per 100,000 live births using SINASC. Mann-Whitney and Fisher's exact tests were applied (P-value < .05). Results: Of 9509 operations, the Southeast region performed 3661 (38.5%), followed by the South region (2261; 23.8%), then the Northeast (2.087; 22%), the Center-West (893; 9.4%), and the North region (607; 6.4%). Overall, in-hospital mortality was 6.4% (609/9509), with significant variation: 11.7% (105/893) in the Center-West and 11.2% (68/607) in the North versus 4.1% (86/2087) in the Northeast (P-value < .0001). Mortality reached 24.6% (79/321) for transposition of the great arteries, 32.9% (24/73) for truncus arteriosus, and 60.4% 125/207) for the Norwood operation. Indexed by live births, the South performed up to 3 times more surgeries than the North. Conclusion: DATASUS National administrative data reveal significant disparities in access and outcomes for CHD surgery in Brazil, with mortality well above international benchmarks. Findings underscore the urgent need for investment in infrastructure, specialized workforce training, and creation of a national registry to improve equity and quality of care for children with CHDs.