Open Access

ARTICLE

Nationwide Trends in Congenital Heart Disease Surgery in Korea, 2002–2018: Volume, Age-Standardized Incidence, and Lesion-Based Case-Mix

Jae Sung Son¹, Soo-Jin Kim^2,*

1 Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea
2 Department of Pediatrics, Sejong General Hospital, Sejong Heart Institute, Bucheon-si, 14754, Gyeonggi-do, Republic of Korea

* Corresponding Author: Soo-Jin Kim. Email:

Congenital Heart Disease 2025, 20(4), 421-440. https://doi.org/10.32604/chd.2025.070250

Received 11 July 2025; Accepted 03 September 2025; Issue published 18 September 2025

Abstract

Background: Advancements in diagnostic tools, surgical techniques, and long-term management have significantly improved survival among individuals with congenital heart disease (CHD), leading to an evolving epidemiologic profile characterized by increasing procedural complexity and a growing adult CHD population. This study aimed to examine nationwide trends in CHD surgeries over a 17-year period, with a focus on temporal shifts in surgical volume, procedural complexity, and age-specific incidence. Methods: A total of 41,608 CHD surgeries and 85,417 surgical procedures performed between 2002 and 2018 were identified from a nationwide health insurance database. Temporal trends were evaluated using segmented linear regression, and age-specific standardized incidence rates were calculated per 100,000 population across three age groups: infants (<1 year), children (1–18 years), and adults (≥19 years). Results: Despite a decline in overall surgical volume (from 2523 in 2002 to 1624 in 2018), the number of surgical procedures rose markedly (from 2936 to 5402), indicating higher claims-based procedural volume per patient (i.e., more billed procedure codes per operation), a proxy for operative intensity rather than a direct measure of clinical or system burden. This divergence was particularly notable in infants and adults, while pediatric surgical rates declined sharply. Age-specific incidence rates of surgical procedures showed a continuous rise in infants and a moderate increase in adults, whereas children demonstrated stable or declining trends. Breakpoints in temporal trends were identified in 2015 for surgeries and 2011 for procedures. Conclusions: The landscape of CHD surgery is undergoing a demographic and clinical transformation, with a shift toward early, complex operations in infants and reoperations in adults. These findings underscore the growing need for age-tailored, resource-intensive care models and long-term strategic planning to accommodate the evolving burden of CHD across the lifespan.

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