Incidence and predictive factors for development of ADHD post congenital heart disease surgery-a single tertiary center experience from India.

Introduction: A recent shift in mortality trends in children with congenital heart disease (CHD) has led to more patients reaching adulthood. Attention-deficit hyperactivity disorder (ADHD) is a prevalent and often underdiagnosed condition, with increased risk observed in children with CHD due to disease- and surgery-related factors. This study aimed to determine the incidence of ADHD one year after cardiac surgery in children and to identify associated clinical and operative risk factors. Methods: Children aged 3-5 years and 6-18 years who were to undergo cardiac surgery for CHD between December 2022 to June 2023, were evaluated pre-operatively and post-operatively ≥1 year after the surgery, after informed written consent. Results: Our study comprised of 98 children. The incidence of ADHD in children 1 year post cardiac surgery was 32.6%. We also found a statistically significant association between post- operative complications, longer CPB time, aortic cross-clamp time, duration of mechanical ventilation, ICU stay, and hospital stay and ADHD. No significant association was found with prior cardiac surgery, cyanosis, intraoperative complications, reintervention, or inotrope duration. CPB time >58 minutes, aortic cross-clamp time >46 minutes, hospital stay >8 days, and ICU stay ≥3 days demonstrated moderate to good predictive accuracy for ADHD. Conclusion: ADHD is a common outcome following pediatric cardiac surgery and is associated with perioperative factors, particularly markers of surgical complexity and postoperative recovery. Early identification using these predictors may help reduce long-term morbidity, though larger studies are needed to validate these findings.