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

Background:Advancements in diagnostic tools,surgical techniques,and long-termmanagement 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.