Luitel Prajjwol, Yadav Rukesh, Neupane Nischal, Paudel Sujan, Adhikari Niranjan, Punukollu Rachana
Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Ann Med Surg (Lond). 2024 Jun 27;86(8):4695-4704. doi: 10.1097/MS9.0000000000002132. eCollection 2024 Aug.
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-income and middle-income countries.
A comprehensive search for articles was performed using the Medline (PubMed), Scopus, and Embase databases from their inception to September 5, 2023. Studies reporting QOL outcomes in children <18 years and published in English were included.
Of the 1239 records screened, 10 studies, including 1721 participants, were included in the study. The overall QOL was significantly better in the control group than in the children who underwent surgery for CHD (=0.04, standard mean difference of -0.62, 95% CI: -1.2 to -0.04), and the overall QOL was significantly better in the children with CHD after surgery than before surgery (=0.05, standard mean difference of -0.56, 95% CI: -1.11 to -0.01).
The QOL of children from low-income 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.
先天性心脏病（CHD）患儿治疗方法的改进引发了人们对长期功能结局（如健康相关生活质量，HRQOL）的日益关注。关于CHD患儿HRQOL的研究结果相互矛盾。在本研究中，我们旨在进行系统评价和荟萃分析，以分析手术对低收入和中等收入国家CHD患儿HRQOL结局的影响。
使用Medline（PubMed）、Scopus和Embase数据库，对从建库至2023年9月5日的文章进行全面检索。纳入报告18岁以下儿童QOL结局且以英文发表的研究。
在筛选的1239条记录中，有10项研究（包括1721名参与者）纳入本研究。总体QOL在对照组显著优于接受CHD手术的儿童（P=0.04，标准化均差为-0.62，95%CI：-1.2至-0.04），且CHD患儿术后总体QOL显著优于术前（P=0.05，标准化均差为-0.56，95%CI：-1.11至-0.01）。
低收入和中等收入国家接受CHD手术的儿童，除情感领域外，在所有维度上的QOL均显著低于对照组。同时，手术对改善CHD患儿术后身体领域的影响最大。应进一步研究改善该亚组患者HRQOL的策略。
