Health-related quality of life outcomes in children after congenital heart disease surgery in low-middle-income countries: A systematic review and meta-analysis

Abstract

Introduction: Improved treatments for children with congenital heart disease (CHD) have led to a growing interest in long-term functional outcomes such as health-related quality of life (HRQoL). Studies on HRQoL in children with CHD have yielded contradictory results. In this study, we aimed to perform a systematic review and meta-analysis to analyze the effect of surgery on HRQoL outcomes in children with CHD in low- and middle-income countries (LMIC). Methods: A comprehensive search for articles was performed using the Medline (PubMed), Scopus and Embase databases from their inception to September 5, 2023. Studies reporting quality of life outcomes in children <18 years and published in English were included. Results: Of the 1,239 records screened, ten studies including 1,721 participants were included in the study. The overall quality of life was significantly better in the control group than in the children who underwent surgery for CHD (P= 0.04, standard mean difference (SMD) of -0.62, 95% CI: -1.2 to -0.04), and the overall quality of life was significantly better in the children with CHD after surgery than before surgery. (P= 0.05, SMD of -0.56, 95% CI: -1.11 to -0.01). Conclusion: The quality of life of children from low- and middle-income countries who undergo surgery for CHD is significantly poorer than that of controls in all dimensions except the emotional domain. Meanwhile, surgery has the greatest impact on improving the physical domain in children with CHD after surgery. Strategies to improve HRQoL in this subgroup of patients should be further investigated.