Predictors of Perioperative Mortality in Paediatric Surgery at a Tertiary Hospital in Sagamu, Nigeria

Background

The burden of surgical diseases in children and perioperative complications in sub-Saharan Africa remains high. The assessment of the pattern and the determinants of perioperative mortality plays an invaluable role in identifying indicators of poor outcomes in order to improve overall outcomes in children’s surgery, thus necessitating this study.

Methods

A retrospective review of medical records of patients aged 15 years and below, who had general pediatric, oncological, and urological surgeries under general anesthesia between January 2014 and December 2023, with complete records up to at least post-surgery or died within 30 days of surgery, was carried out. Information extracted included biodata, diagnosis, ASA classification of physical status, time of death after surgery, cause of death, and duration of surgery. Data were collated and analyzed using univariate and multivariate statistical tools.

Results

A total of 1621 patients were analyzed. The 30-day perioperative mortality rate in this study was 2.96% (296 per 10,000 patients); jejuno-ileal atresia, gastrochisis and bladder exstrophy are the conditions associated with the highest mortality rates, well above 50%. Furthermore, logistic regression model identified neonatal age group, ASA class greater than II and repeated surgical procedures as the significant predictors of mortality, while sepsis and intestinal/anastomosis failure were identified as the most common direct cause of death.

Conclusion

Neonatal age group, ASA class greater than II, and repeated surgery are the significant predictors of mortality in children’s surgery in our practice. Efforts should be made to combat sepsis and provide physiologic support and intensive care to improve outcomes.

Key messages

What is already known about this subject:

• Perioperative mortality rate in pediatric surgery in sub-Saharan Africa remains high.

• Only a few studies in the region have attempted to identify predictors of POM in children.

What this study adds

• This study revealed the real burden of POM in our practice and identified the determinants of poor outcomes

• Neonatal age group, high ASA classification and repeated surgeries are significant predictors of mortality in this study

• Jejuno-ileal atresia and gastrochisis are associated with a high case fatality rate.

How this study might affect research, practice or policy

• Findings from this study provide potential tools to improve outcomes in pediatric surgery in the region.