Perioperative mortality in children in a tertiary teaching hospital in Nigeria: a prospective study

Abstract

BackgroundPerioperative mortality is one of the tools that can help to assess the adequacy of healthcare delivery in a nation. This audit was conducted to determine the 24-hour, 7-day and 30-day perioperative mortality rates and the predictors of mortality in a pediatric surgical cohort.MethodsThis was a prospective study of children whose ages ranged from a few hours to 15 years and who were operated on between May 2019 and April 2020. The primary outcome was to determine the incidence of in-hospital perioperative mortality.ResultsA total of 530 procedures were done in 502 children. Their ages ranged from a few hours to 15 years with a median of 36 months. The 24-hour, 7-day and 30-day mortality rates were 113.2 per 10 000 procedures [95% confidence interval (CI) =40 to 210], 207.6 per 10 000 procedures (95% CI=110 to 320) and 320.8 per 10 000 procedures (95% CI=190 to 470), respectively. Congenital anomalies complicated by postoperative sepsis contributed to death in the majority of cases. The predictors of mortality were neonatal age group [adjusted odds ratio (AOR)=19.92, 95% CI=2.32 to 170.37, p=0.006], higher American Society of Anesthesiologists Physical Status III and above (AOR=21.6, 95% CI=3.05 to 152.91, p=0.002), emergency surgery (AOR=17.1, 95% CI=5.21 to 60.27, p=0.001), congenital anomalies (AOR=12.7, 95% CI=3.37 to 47.52, p=0.001), and multiple surgical procedures (AOR=9.7, 95% CI=2.79 to 33.54, p=0.001).ConclusionPerioperative mortality remains high in our institution.

Factors Affecting Survival in Nontraumatic Pediatric Abdominal Surgical Emergencies: A Contemporary Review

“…Surgical acute abdominal pain occurred in 10%-30% of children who arrive at the emergency room with acute abdominal pain; however, surgical acute abdominal pain occurred in only 2% of the pediatric patients who came with pain in the abdomen [ 21 ]. The most common reason for children's emergency hospitalizations is pediatric abdominal surgical emergency (PASE), which forms approximately 2.4%-3.1% of all admissions in the pediatric age group [ 22 ]. About 4% of pediatric admissions in Tanzania are abdominal surgical emergencies according to Mhando et al [ 9 ] (2008).…”

“…Remote organ failure, postoperative anastomotic leaking, intraperitoneal abscess, and typhoid perforation of the gastrointestinal tract have all been linked to a poor prognosis [ 24 ]. Patients who develop complications are more likely to be admitted for an extended period of time, which results in higher hospital costs [ 22 ].…”

“…While the POMR in PASE in the United States has been steadily declining for the past 30 years, preventable morbidity and mortality in low- and middle-income countries (LMICs) has remained high [ 22 ]. Only a few case series on pediatric POMR in LMICs have been published in peer-reviewed journals, the majority of which are retrospective and reveal a high mortality rate in children.…”

“…Only a few case series on pediatric POMR in LMICs have been published in peer-reviewed journals, the majority of which are retrospective and reveal a high mortality rate in children. According to Talabi et al, POMRs within 24 hours, seven days, and 30 days were 113.2, 207.6, and 320.8, respectively, per 10,000 operations [ 22 ]. These figures are greater than those reported by HICs.…”

“…This is due to the serious condition in which some children with PASE present to the hospital [ 30 ]. Anesthesia-related deaths were 2-3 times higher in middle-income nations and could be 1,000-fold higher in some resource-poor countries [ 22 ].…”