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Abstract：
Background: Congenital heart disease (CHD) is the leading birth defect in China, and many patients require congenital heart surgery (CHS) to achieve optimal outcomes. However, the current landscape and population accessibility to specialist resources for CHS in China are unclear. Methods: Care facilities performing CHS were identified from the 2018 white book of Chinese cardiovascular surgery and were categorized as full or limited facilities based on specialist capacity. Census-based population data and road data were obtained from administrative sources. Service area analysis of all facilities was performed to estimate geographic accessibility. Results: Of 93 facilities in 14 provinces and municipalities in northern China, only 30.1% had full specialist capacity. The shortage of pediatric cardiologists and mechanical circulatory support was the primary limiting factor. In 2018, 61.3% of facilities performed <200 CHS cases, and 31.6% of all CHS cases (N = 30,921) were performed in limited facilities with substantially lower volume than full-capacity facilities (median value: 85.0 vs. 368.0). Beijing had a disproportionately higher CHS volume (367 cases per million population) than other provinces. Of all children under 5 in northern China, only 12.9% live within 30 km (a typical half-day visit) of the service areas of all facilities. Compared to children from the eastern region (31.4%), 71.8% of children from the central region and 70.2% of children from the western region needed to travel >180 km (a typical overnight visit) to receive care in full-capacity facilities. Conclusions: Many facilities for CHS in northern China had limited specialist capacity, and many CHD patients received suboptimal surgical care. Policy measures should address the significant geographic disparities to receive high-quality surgical care among disadvantaged patients.
摘要：
背景:先天性心脏病(CHD)是我国主要的出生缺陷,许多患者需要先天性心脏手术（CHS）以达到最佳效果。然而,目前尚不清楚中国CHS专业资源的景观和人口可及性。方法：从2018年《中国心血管外科白皮书》中确定了执行CHS的护理设施，并根据专家能力将其分为完整或有限设施。基于人口普查的人口数据和道路数据是从行政来源获得的。对所有设施进行了服务区域分析，以估计地理可达性。结果：在中国北方14个省市的93个设施中，只有30.1%具备充分的专家能力。儿科心脏病专家和机械循环支持的短缺是主要限制因素。2018年，61.3%的设施执行<200CHS病例，所有CHS病例中有31.6％（N=30,921）是在有限的设施中进行的，其容量大大低于全容量设施（中位数：85.0vs.368.0).北京的CHS数量（每百万人口367例）比其他省份高得多。在中国北方所有5岁以下的儿童中，只有12.9%的人居住在所有设施服务区30公里范围内(典型的半天访问)。与东部地区的儿童(31.4%)相比,来自中部地区的71.8％的儿童和来自西部地区的70.2％的儿童需要旅行>180公里（典型的过夜访问）才能在全容量设施中接受护理。结论：中国北方的许多CHS设施的专家能力有限，许多冠心病患者接受了不理想的手术治疗。政策措施应解决弱势患者在接受高质量手术护理方面存在的重大地理差异。
