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Published on: January 27, 2010
Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana
Sarah Peiffer1, Anna E Ssentongo2, Laura Keeney2
1Penn State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA. speiffer@pennstatehealth.psu.edu.
Insights
Malaria significantly increases readmission risk in pediatric surgical patients in Ghana. Addressing malaria, ensuring insurance, and improving surgical resources can reduce complications and improve outcomes.
Area of Science:
- Pediatric Surgery
- Global Health
- Surgical Outcomes
Background:
- Perioperative complications are a major cause of pediatric morbidity and mortality in low- and lower-middle-income countries.
- Eastern Regional Hospital (ERH) in Ghana faces challenges in pediatric surgical care.
Purpose of the Study:
- To investigate factors associated with prolonged length of stay (LOS), 90-day readmission, and in-hospital mortality in pediatric patients at ERH, Ghana.
- To identify key risk factors for adverse perioperative outcomes in a rural Ghanaian setting.
Main Methods:
- Retrospective review of pediatric surgeries performed at ERH between January 2015 and December 2017.
- Analysis of 468 pediatric patients (<18 years) using univariate and multivariable logistic regression.
Main Results:
- Median length of stay (LOS) was 3 days; 90-day readmission and in-hospital mortality rates were 13.8% and 1.7%, respectively.
- Prolonged LOS was linked to gastrointestinal surgery, surgical trauma, infection, and lack of insurance.
- Young age and female gender correlated with in-hospital mortality, while malaria was a significant risk factor for 90-day readmission.
Conclusions:
- Malaria infection is a critical risk factor for pediatric surgical readmissions in rural Ghana and requires prompt investigation and treatment.
- Strategies to improve outcomes include ensuring universal health insurance, adopting minimally invasive techniques like laparoscopy for gastrointestinal surgeries, and expanding the pediatric surgical workforce.
Background/Purpose:
Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients at Eastern Regional Hospital (ERH) in Ghana.
Methods:
This is a retrospective review of perioperative morbidity and mortality in children < 18 years at ERH in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study. Univariate analysis was performed using Pearson's chi-square tests or Fisher's exact tests. Variables that were significant on univariate analysis were included in multivariable logistic regression models adjusted for age and gender.
Results:
We analyzed 468 patients < 18 years of age with a median length of stay (LOS) of 3 days. The 90-day readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19 %) and appendectomy (15 %). Gastrointestinal surgery, surgical trauma, surgical infection and lack of insurance were significantly associated with prolonged LOS. Young age and female gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission.
Conclusions:
Malaria infection is a significant risk factor for readmission, which should be investigated and treated in pediatric surgical patients in rural Ghana. Ensuring that all patients have insurance may result in shorter hospital stays. Provision of laparoscopic equipment may reduce hospital stays for patients undergoing gastrointestinal surgery. Expansion of the surgical work force, particularly pediatric surgeons, could improve perioperative survival in the very young population.
Level Of Evidence:
Retrospective comparative study.
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