• health outcomes research
• patient perspective

At first glance, the suggestion that having open heart surgery in the first few weeks of life makes you a happier person is hard to believe. However, in their large-scale study, involving more than 500 children with congenital heart disease (CHD), Reiner et al 1 propose just that; self-reported health-related quality of life (HRQoL) scores, as measured by the KINDL, were significantly higher in patients with CHD when compared with age-matched controls (78.6 vs 75.6; p<0.001). Furthermore, the results were consistent across all severity classes and diagnostic subgroups. Despite the steady advances in surgical techniques and medical management of these patients, these findings do not, at first glance, seem logical. A systematic review published in Archives in 2017 of postoperative patients with CHD found general HRQoL was worse in patients compared with controls with a standard mean difference of −0.56 (physical functioning) and −0.44 (psychosocial functioning).2 So why the discrepancy between studies, and wherein lies the truth?

Before we get into the specifics of this study, …