Skip to main content Accessibility help

Comparison of outcomes in Australian indigenous and non-indigenous children and adolescents undergoing cardiac surgery

  • Edward R. Justo (a1), Benjamin M. Reeves (a2), Robert S. Ware (a1) (a3), Janelle C. Johnson (a4), Tom R. Karl (a1) (a5), Nelson D. Alphonso (a1) (a4) and Robert N. Justo (a1) (a4)...



Population-based registries report 95% 5-year survival for children undergoing surgery for CHD. This study investigated paediatric cardiac surgical outcomes in the Australian indigenous population.


All children who underwent cardiac surgery between May, 2008 and August, 2014 were studied. Demographic information including socio-economic status, diagnoses and co-morbidities, and treatment and outcome data were collected at time of surgery and at last follow-up.


A total of 1528 children with a mean age 3.4±4.6 years were studied. Among them, 123 (8.1%) children were identified as indigenous, and 52.7% (62) of indigenous patients were in the lowest third of the socio-economic index compared with 28.2% (456) of non-indigenous patients (p⩽0.001). The indigenous sample had a significantly higher Comprehensive Aristotle Complexity score (indigenous 9.4±4.2 versus non-indigenous 8.7±3.9, p=0.04). The probability of having long-term follow-up did not differ between groups (indigenous 93.8% versus non-indigenous 95.6%, p=0.17). No difference was noted in 30-day mortality (indigenous 3.2% versus non-indigenous 1.4%, p=0.13). The 6-year survival for the entire cohort was 95.9%. The Cox survival analysis demonstrated higher 6-year mortality in the indigenous group – indigenous 8.1% versus non-indigenous 5.0%; hazard ratio (HR)=2.1; 95% confidence intervals (CI): 1.1, 4.2; p=0.03. Freedom from surgical re-intervention was 79%, and was not significantly associated with the indigenous status (HR=1.4; 95% CI: 0.9, 1.9; p=0.11). When long-term survival was adjusted for the Comprehensive Aristotle Complexity score, no difference in outcomes between the populations was demonstrated (HR=1.6; 95% CI: 0.8, 3.2; p=0.19).


The indigenous population experienced higher late mortality. This apparent relationship is explained by increased patient complexity, which may reflect negative social and environmental factors.


Corresponding author

Correspondence to: Associate Professor R. N. Justo, Queensland Paediatric Cardiac Service, Lady Cilento Children’s Hospital, 501 Stanley Street, South Brisbane, QLD 4101, Australia. Tel: +617 3068 5108; Fax: +617 3068 3169; E-mail:


Hide All
1. Erikssen, G, Liestol, K, Seem, E, et al. Achievement in congenital heart surgery: a prospective 40-year study of 7038 patients. Circulation 2015; 131: 337346.
2. Raissadati, A, Nieminen, H, Jokinen, E, Sairanen, H. Progress in late results among pediatric cardiac surgery patients: a population-based 6-decade study with 98% follow-up. Circulation 2015; 131: 347353.
3. Oster, ME, Strickland, MJ, Mahle, WT. Racial end ethnic disparities in post-operative mortality following congenital heart surgery. J Pediatr 2011; 159: 222226.
4. Benavidez, OJ, Gauvreau, K, Jenkins, KJ. Racial and ethnic disparities in mortality following congenital heart surgery. Pediatr Cardiol 2006; 27: 321328.
5. Bolisetty, S, Daftary, A, Ewald, D, Knight, B, Wheaton, G. Congenital heart defects in central Australia. Med J Australia 2004; 180: 614617.
6. Bower, C, Ramsay, JM. Congenital heart disease: a 10-year cohort. Paediatr Child Health 1994; 30: 414418.
7. Alizzi, AM, Knight, JL, Tully, PJ. Surgical challenges in rheumatic heart disease in the Australian indigenous population. Heart Lung Circ 2010; 19: 295298.
8. Weimers, P, Marney, L, Muller, R, et al. Cardiac surgery in indigenous Australians – how wide is the gap? Heart Lung Circ 2014; 23: 265272.
9. Prabhu, A, Tully, PJ, Bennetts, JS, Tuble, SC, Baker, RA. The morbidity and mortality outcomes of indigenous Australian peoples after isolated coronary artery bypass surgery: the influence of geographic remoteness. Heart Lung Circ 2013; 22: 599605.
10. Russell, EA, Tran, L, Baker, RA, et al. A review of outcome following valve surgery for rheumatic heart disease in Australia. BMC Cardiovasc Disord 2015; 15: 103115.
11. Padley, JR, Cole, AD, Pye, VE, et al. Five-year analysis of operative mortality and neonatal outcomes in congenital heart disease. Heart Lung Circ 2011; 20: 460467.
12. Rohde, SL, Matebele, M, Pohlner, P, Radford, D, Wall, D, Fraser, JF. Excellent cardiac surgical outcomes in paediatric indigenous patients, but follow-up difficulties. Heart Lung Circ 2010; 19: 517522.
13. Pink, B. Socio-economic indexes for areas (SEIFA). Australian Bureau of Statistics; Catalogue Number 2033.0.55.001; 2013: 1–81.
14. Lacour-Gayet, F, Clark, D, Jacobs, J, et al. The Aristotle score for congenital heart surgery. Semin Thorac Cardiovasc Pediatr Card Surg Annu 2004; 7: 185191.
15. Austin, PC. Optimal caliper widths for propensity score-matching when estimating differences in means and differences in proportions of observational studies. Pharm Stat 2011; 10: 150161.
16. Austin, PC. An introduction to propensity score methods for reducing effects of confounding in observational studies. Multivariate Behav Res 2011; 46: 399424.
17. Queensland Office of Economic and Statistical Research. Census 2011: Aboriginal and Torres Strait Islander Population in Queensland, 2nd edn; 2013. Retrieved August 10, 2015 from
18. Atler, DA. Merits and pitfalls of using observational ‘big data’ to inform our understanding of socioeconomic outcome disparities. J Am Coll Cardiol 2015; 66: 18981900.
19. Dalen, M, Ivert, T, Holzmann, MJ, Sartipy, U. Household disposable income and long-term survival after cardiac surgery: a Swedish nationwide cohort study in 100,534 patients. J Am Coll Cardiol 2015; 66: 18881897.
20. Reeve, C, Humphreys, J, Wakerman, J, Carter, M, Carroll, V, Reeve, D. Strengthening primary health care: achieving health gains in a remote region of Australia. Med J Aust 2015; 202: 483488.
21. Zhao, Y, Thomas, SL, Guthridge, SL, Wakerman, J. Better health outcomes at lower costs: the benefits of primary care utilization for chronic disease management in remote Indigenous communities in Australia’s Northern Territory. BMC Health Serv Res 2014; 14: 463472.
22. Sly, JL, Moore, SE, Gore, F, et al. Children’s environmental health indicators in Australia. Ann Global Health 2016; 82: 156168.
23. Australian Institute of Health and Welfare (AIWH). Better Cardiac Care Measures for Aboriginal and Torres Strait Islander People: First National Report 2015. Catalogue Number IHW 156. AIWH, Canberra; 2015: 44–50.


Type Description Title
Supplementary materials

Justo supplementary material
Tables S1-S2

 Word (36 KB)
36 KB


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed