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South African Paediatric Surgical Outcomes Study: a 14-day prospective, observational cohort study of paediatric

A Torborg1, L Cronje1, J Thomas2

  • 1Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa.

British Journal of Anaesthesia
|January 29, 2019
PubMed

Insights

Paediatric surgery in sub-Saharan Africa has a 9.7% complication rate, with infections being most common. In-hospital mortality is significantly higher than in high-income countries, highlighting a critical need for improved care strategies.

Area of Science:

  • Global Health
  • Surgical Outcomes
  • Paediatric Medicine

Background:

  • Sub-Saharan Africa has a high paediatric population, with surgical disease burden exceeding available resources.
  • Limited prospective studies exist on paediatric perioperative outcomes in low- and middle-income countries (LMICs).

Purpose of the Study:

  • To prospectively investigate paediatric perioperative outcomes in South African government-funded hospitals.
  • To identify the incidence, types, and risk factors of postoperative complications in paediatric surgical patients in an LMIC setting.

Main Methods:

  • A 14-day multicentre, prospective, observational cohort study.
  • Recruited 2024 paediatric patients (<16 yrs) across 43 hospitals in South Africa.
  • Primary outcome: incidence of in-hospital postoperative complications.

Main Results:

  • Overall postoperative complication incidence was 9.7% (95% CI: 8.4-11.0), with infective complications being most common (7.3%).
  • In-hospital mortality rate was 1.1% (95% CI: 0.6-1.5).
  • Preoperative risk factors for complications included ASA physical status, surgical urgency, severity, and infective indication.

Conclusions:

  • Paediatric surgical complication profiles and risk factors differ between LMICs and high-income countries.
  • In-hospital mortality in this LMIC setting is approximately 10 times higher than in high-income countries.
  • Findings underscore the need for targeted strategies and further research to enhance paediatric surgical outcomes in LMICs.
Abstract

Keywords:
anesthesiologydeveloping countrieshospital mortalityoutcome assessment (healthcare)pediatricspostoperative complicationsprospective studiesspecialties, surgical

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