Epidemiological changes in child surgical activity. Analysis of 17 years in a tertiary care hospital in Mexico

Abstract

Background: Surgical care is an essential component to achieve universal health coverage. An increase in children's surgical burden is recognized worldwide, but changes in the epidemiological profile associated with global geographic heterogeneity are to be expected. The aims of this study are to analyse the prevalence and epidemiological changes of surgical activity in a tertiary center in Mexico. Methods: Ambispective cohort study. Institutional records were reviewed searching for children’s surgeries in the period comprising 2001-2017. The variables analyzed were age, sex, number of surgeries per subject, and mortality rate; regarding the interventions, kind of inward stay, kind of surgery (ICD 9 CM), ward or department responsible, and perioperative mortality rate (POMR). Results: Of the 104,578 institutional admissions, 37% were surgical procedures of preschool-aged children (30.2%), and infants (27.3%). These tended to decrease, while for adolescents to increase. A total of 84,859 surgeries were performed (1.36 per operating room/day), averaging 4.992 per year, with a marginal tendency to increase. 65.8% of procedures required hospitalization. The systems more frequently intervened were: musculoskeletal system (20.1%, tending to increase), digestive system (19.5%), and cardiovascular system (11.3%). The overall mortality rate of surgical admissions was 5.5%, with POMR of 1.54%. Conclusion: The institutional epidemiological profile has changed, and relevant trends were identified. We corroborated the presence of global geographic heterogeneity with analogous hospitals