@Article{chd.2025.070250,
AUTHOR = {Jae Sung Son, Soo-Jin Kim},
TITLE = {Nationwide Trends in Congenital Heart Disease Surgery in Korea, 2002–2018: Volume, Age-Standardized Incidence, and Lesion-Based Case-Mix},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {20},
YEAR = {2025},
NUMBER = {4},
PAGES = {421--440},
URL = {http://www.techscience.com/schd/v20n4/63766},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> 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. <b>Methods:</b> 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). <b>Results:</b> 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. <b>Conclusions:</b> 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.},
DOI = {10.32604/chd.2025.070250}
}