Ethnicity and survival after paediatric cardiac surgery in the UK

Objectives: To assess the impact of ethnicity on survival following paediatric cardiac surgery.

Methods: Observational study of a regional tertiary paediatric cardiac surgical centre in Yorkshire, UK. All children (age 0–15 years) undergoing their first cardiac surgical procedure from January 2005 to December 2021 inclusive. The primary outcome was 5-year survival. Secondary outcomes included 30-day, 1-year, and pre-discharge survival.

Results: 3,508 children (46% female) underwent their first cardiac surgical procedure during the study period. Within the study cohort 2,578 (73%) children were White, 634 (18%) were South Asian, 95 (3%) were Black and 201 (6%) were from other ethnic groups. South Asian children were more likely to have a functionally single-ventricle (10% vs. 7% White; relative risk 1.41, 95% confidence interval 1.15–1.69).

Mortality after surgery, adjusted for deprivation, was higher for South Asian (hazard ratio 1.50, 1.12–2.01) and Black children (hazard ratio 1.69, 0.93–3.06), compared to White children. Survival differences were not present at discharge or 30 days post-procedure, but widened progressively at 90 days, 1 year and 5 years. This was not influenced by diagnosis or pre-operative risk factors. One-year survival improved for South Asian children across the study period and was similar to that of White children from 2017–2021 (94.7% (89.8–97.3%) vs. 96.8% (94.9–97.9%) White).

Conclusions: Black and South Asian children have a greater risk of death following cardiac surgery compared to White children, independent of pre-operative risk. The majority of excess deaths occurred after hospital discharge. Although inequities have steadily reduced over the past two decades, the explanation for this effect remains unclear.