Impact of Specialist Pediatric Cardiac Transfer on Unplanned Emergency Operations and Mortality in Neonates with Critical Congenital Heart Disease

Background Neonates with critical congenital heart disease (CCHD) often require early surgical intervention to survive.This study aimed to evaluate whether specialist pediatric cardiac transfer (SPCT) improves surgical outcomes in neonates with critical congenital heart disease (CCHD). Methods In this retrospective cohort study, we collected clinical data of neonates diagnosed with CCHD who were treated at the cardiac intensive care unit of Shanghai Children’s Medical Center between January 2019 and December 2022. Propensity score matching (PSM) was used to balance the SPCT and non-SPCT groups. The primary outcome was postoperative survival. Results This study included 357 neonates with CCHD. After propensity score matching (PSM), the SPCT group had significantly lower rates of inotropic drug use (57.3% vs. 77.5%, p = 0.004), unplanned emergency operations (29.2% vs. 53.9%, p = 0.001), and preoperative mortality (0% vs. 4.5%, p = 0.043) compared to the non-SPCT group. Additionally, overall survival was higher in the SPCT group (92.6% vs. 82.0%, p = 0.044). Postoperative mortality did not significantly differ between the groups (2.25% in the SPCT group vs. 7.87% in the non-SPCT group, p = 0.065). However, long-distance transport showed significantly lower overall mortality in the L-SPCT group compared to the L-N-SPCT group (2.67% vs. 12.5%, p = 0.049). Multivariate analysis revealed low body weight at surgery (hazard ratio [HR]: 0.444, 95% confidence interval [CI]: 0.273–0.711, p = 0.001), Non-SPCT long distance transport (HR: 4.608, 95% CI: 1.436–4.982, p =0.017)and unplanned emergency operation (HR: 5.227, 95% CI: 2.521–10.834, p < 0.001) as independent risk factors for surgical mortality in neonates with CCHD. Conclusions SPCT reduces the rate of unplanned emergency operations and increases overall survival in neonates with CCHD, particularly in long-distance transfers.