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Pediatric day case surgery: experience from a tertiary health institution in Nigeria
L O Abdur-Rahman1, I K Kolawole, J O Adeniran
1Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria. bolarjide@yahoo.com
Insights
Pediatric day case surgery is a safe and feasible option in developing countries, with high parent satisfaction and no unplanned admissions. This approach can help reduce surgical waiting lists for children.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Healthcare Management
Background:
- Home environment convalescence supports day case surgery adoption in developing nations.
- Pediatric surgical services face high demand and resource limitations in developing countries.
Purpose of the Study:
- To evaluate the feasibility and outcomes of pediatric day case surgery (PDS) in a developing country setting.
- To assess parental satisfaction and identify factors influencing PDS in pediatric surgical units.
Main Methods:
- Prospective data collection on pediatric day surgeries over 2.5 years at University of Ilorin Teaching Hospital.
- Pre-operative outpatient briefing and post-operative interviews with parents on days 2 and 9.
- Analysis of demographic data, surgical indications, parental proximity, education, and factors causing delays.
Main Results:
- 449 out of 660 elective pediatric cases (68.02%) were performed as day cases.
- Congenital hernias/hydroceles were the most common indication (71.2%).
- Logistics and patient fitness were significant delay factors (P=0.001); 98.9% of parents lived within 20 km and could reach the hospital within 1 hour.
Conclusions:
- Pediatric day case surgery is feasible for well-selected and monitored cases, with high parental satisfaction and no mortality or unplanned admissions.
- Term neonates with informed parents are suitable candidates for PDS.
- Establishing a dedicated day case center is recommended to reduce surgical waiting lists.
Background:
The general observation that children achieve better convalescence in the home environment supports the need for adoption of day case surgery, which is gaining considerable acceptance in developing countries. Pediatric surgical service is in great demand in developing countries, and in-patient beds and surgical supplies are insufficient.
Method:
A prospective collection of data on all pediatric day surgeries (PDSs) by the pediatric surgical unit University of Ilorin Teaching Hospital (UITH, Ilorin, was done. Parents had pre-operative outpatient briefing and postoperative interviews on the second and ninth days for consultation regarding post-operative complications and events at home. Study period was between April 2005 and September 2007 (2(1/2) years).
Results:
Of the 660 elective cases, 449 (68.02%) children were recruited as day cases. The male-to-female ratio was 14.3:1. Age ranged between 20 days and 15 years with a mean of 37.6 months and standard deviation (SD) of 34.4 months. Congenital hernias/ hydroceles were the highest indications (71.2%), followed by lump/ masses (12.9%), undescended testes (8.7%), umbilical hernias (4.8%) and thyroglossal duct cyst (2.5%). In 98.9% of cases, the parents resided within 20 km radius of the hospital, and 91.5% of them could reach the hospital within 1 hour. Fathers and mothers of 80.1% and 77.1% of children, respectively, had above-primary education. More than half of the fathers (55%) were civil servants, while 30% were self-employed. The mothers were civil servants in 37.3% of cases, and 34% were self-employed. The average number of outpatient clinic visits before surgery was 2-3 visits (41.2%) with mean interval to surgery of 4-5 weeks (60.3%). Logistics (investigations and availability of operation list) and patient's fitness for surgery were statistically significant delay factors (P= 0.001).
Conclusion:
Parents reported 14 children to be irritable at home due to pain, while the others reported satisfactory day case experience. No unplanned admission or mortality was recorded, and only 3 (0.8%) parents would not recommend day case surgery to other people.
Conclusion:
Pediatric day case surgery is feasible for well-selected and monitored cases in our environment. Term neonates with informed parents are suitable for pediatric day case surgery. There is a need for a day case center to reduce waiting list at UITH.
