Nationwide Analysis of Surgery and Catheterization Services for Congenital Heart Disease: Regional Disparities and Patient Migration in Korea.

BACKGROUND: Despite advancements in congenital heart disease (CHD) outcomes in Korea, equitable access to pediatric cardiac care is challenged by significant regional disparities. This study aimed to evaluate nationwide patterns of CHD surgeries and catheterizations, focusing on regional access and patient migration factors. METHODS: Using the National Health Insurance Sharing Service database, we conducted procedure-level, cross-sectional analyses of CHD patients (aged 0-19 years) using datasets from 2012, 2017, and 2022. We measured volumes, regional utilization ratio (RUR), and migration. RUR was defined as the number of procedures performed within a region divided by the procedures received by its residents. Multivariable logistic regression identified determinants of out-of-region care. RESULTS: We analyzed 6,438 surgeries and 11,276 catheterizations. Surgical volume declined but the proportion of complex surgeries rose from 42.9% in 2012 to 54.1% in 2022. Surgical care was highly centralized in Seoul (RUR > 4.0 in 2022). Out-of-region surgery was more likely for complex procedures, cyanotic CHD, and age 1-5 years; 53.8% of surgeries were performed outside the residential regions. Catheterization volume increased nationally with rising regional RUR. The proportion of inter-regional catheterizations decreased from 29.2% in 2012 to 15.2% in 2022. However, migration remained more frequent among infants, those with cyanotic CHD, higher socioeconomic status, and cardiac disability registration. CONCLUSION: Regional disparity persists in Korean pediatric CHD care, with marked centralization of surgery in Seoul. Regional access to catheterization has improved, yet high-risk subgroups (infants and cyanotic CHD) continue to receive out-of-region care. Strategic investment in regional infrastructure and workforce development, combined with efforts to shift patient perceptions and strengthen institutional collaborations, are essential to ensuring timely, equitable, and high-quality CHD care for all children across Korea.