Background Duct-dependent congenital heart diseases (CHDs) require prompt postnatal intervention to prevent life-threatening deterioration. While prenatal diagnosis may improve outcomes, the impact of route of admission on preoperative mortality remains unclear in Japan. Methods This cross-sectional study examines the impact of the route of admission on preoperative mortality in 2704 admissions of patients with duct-dependent CHD between 2014 and 2019, at hospitals employing the Diagnostic Procedure Combination payment system. The route of admission was categorized as either born in hospital or admitted from outside the hospital. Results The risk of preoperative death was higher among patients admitted from out-of-hospital in CHDs with duct-dependent systemic circulation (adjusted odds ratio = 3.41, 95% confidence interval (CI): 1.16, 10.04) compared with the ones born in the hospital. The risk was especially pronounced in those with hypoplastic left heart syndrome (adjusted odds ratio = 15.78, 95% CI: 3.36, 74.17). The population attributable fraction associated with out-of-hospital birth was 53.8% (95% CI: 7.2%, 81.4%) for CHDs with duct-dependent systemic circulation and 83.5% (95% CI: 44.7%, 96.2%) for hypoplastic left heart syndrome Conclusion For CHDs with duct-dependent systemic circulation, particularly hypoplastic left heart syndrome, early diagnosis and planned delivery may improve pre-operative mortality. Impact <UnorderedList Mark="Bullet"> <ItemContent> This study demonstrates a significantly higher risk of preoperative death among pediatric congenital heart diseases patients with duct-dependent systemic circulation, especially hypoplastic left heart syndrome, when admitted from out-of-hospital compared to being born in hospital. Early diagnosis and planned delivery at specialized facilities can substantially improve survival. </ItemContent> <ItemContent> By focusing specifically on preoperative mortality and distinguishing congenital heart diseases that require timely interventions, this study provides novel insights into the critical importance of the admission pathway for preoperative mortality, complementing previous research. </ItemContent> <ItemContent> The findings support strengthening prenatal screening and promoting planned deliveries to improve survival outcomes in congenital heart diseases with duct-dependent systemic circulation. </ItemContent> </UnorderedList>

Association between route of admission and preoperative mortality in patients with duct-dependent congenital heart disease

期刊论文
发表日期：

2026年4月29日

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Atsuna Tokumoto,
Nobutoshi Nawa,
Kiyohide Fushimi,
Taku Ishii,
Takeo Fujiwara

摘要

Background

Duct-dependent congenital heart diseases (CHDs) require prompt postnatal intervention to prevent life-threatening deterioration. While prenatal diagnosis may improve outcomes, the impact of route of admission on preoperative mortality remains unclear in Japan.

Methods

This cross-sectional study examines the impact of the route of admission on preoperative mortality in 2704 admissions of patients with duct-dependent CHD between 2014 and 2019, at hospitals employing the Diagnostic Procedure Combination payment system. The route of admission was categorized as either born in hospital or admitted from outside the hospital.

Results

The risk of preoperative death was higher among patients admitted from out-of-hospital in CHDs with duct-dependent systemic circulation (adjusted odds ratio = 3.41, 95% confidence interval (CI): 1.16, 10.04) compared with the ones born in the hospital. The risk was especially pronounced in those with hypoplastic left heart syndrome (adjusted odds ratio = 15.78, 95% CI: 3.36, 74.17). The population attributable fraction associated with out-of-hospital birth was 53.8% (95% CI: 7.2%, 81.4%) for CHDs with duct-dependent systemic circulation and 83.5% (95% CI: 44.7%, 96.2%) for hypoplastic left heart syndrome

Conclusion

For CHDs with duct-dependent systemic circulation, particularly hypoplastic left heart syndrome, early diagnosis and planned delivery may improve pre-operative mortality.

Impact

This study demonstrates a significantly higher risk of preoperative death among pediatric congenital heart diseases patients with duct-dependent systemic circulation, especially hypoplastic left heart syndrome, when admitted from out-of-hospital compared to being born in hospital. Early diagnosis and planned delivery at specialized facilities can substantially improve survival.

By focusing specifically on preoperative mortality and distinguishing congenital heart diseases that require timely interventions, this study provides novel insights into the critical importance of the admission pathway for preoperative mortality, complementing previous research.

The findings support strengthening prenatal screening and promoting planned deliveries to improve survival outcomes in congenital heart diseases with duct-dependent systemic circulation.