Outcomes of congenital heart disease procedures in Pakistan: a retrospective cohort study using a publicly funded congenital heart surgery programme registry.

OBJECTIVES

The objective of this study was to evaluate factors associated with in-hospital periprocedural mortality and length of stay (LOS) among patients treated through a publicly funded programme such as Pakistan's Chief Minister's Congenital Heart Surgery Program (CMCHSP), including impact of socioeconomic factors.

STUDY

DESIGN

Retrospective cohort study using the CMCHSP registry.

PARTICIPANTS

Patients undergoing congenital cardiac interventions between January 2024 and August 2025, across multiple public and private hospitals in Punjab, Pakistan.

METHODS

Primary outcomes were in-hospital periprocedural mortality and hospital LOS. Procedural complexity was classified using the Risk Adjustment for Congenital Heart Surgery (RACHS) system. Socioeconomic status was assessed using Proxy Means Test scores. Multivariable logistic and linear regression models were used to evaluate risk-adjusted associations with mortality and LOS, accounting for clustering at the patient level.

RESULTS

A total of 5431 patients underwent 5744 procedures, of which 55.3% were surgical and 44.7% catheter-based. The cohort was predominantly paediatric (87.1%) and had a median age of 6.0 years. Mortality increased significantly with procedural complexity, ranging from 1.46% in RACHS category 1 to 30.23% in category 4 (p<0.001). On multivariable analysis, each increase in RACHS category was associated with higher odds of mortality (adjusted OR 2.08, 95% CI 1.57 to 2.76). Urgent procedures were also associated with increased mortality (aOR 1.68, p=0.046). Socioeconomic status was not independently associated with mortality. Higher procedural complexity, treatment in public hospitals and greater distance-to-care were associated with prolonged LOS.

CONCLUSION

In this large, programme-based cohort, outcomes were influenced by procedural complexity and clinical factors rather than socioeconomic status once access to care was achieved. These findings suggest that publicly financed congenital heart disease programmes can deliver equitable short-term outcomes, though system-level barriers continue to influence resource utilisation.