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28-day perioperative pediatric mortality and its predictors in a tertiary teaching hospital in Ethiopia: a
Misganew Terefe Molla1, Nebiyu Shitaye Anley2, Bekalu Wubshet Zewdie3
1Department of Anesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia. misganterefe@gmail.com.
Insights
Perioperative pediatric mortality remains high in low-resource settings. Neonatal age, blood transfusions, and severe American Society of Anesthesiologists physical status were key predictors of mortality within 28 days post-surgery.
Area of Science:
- Pediatric Surgery
- Global Health
- Anesthesiology
Background:
- Perioperative pediatric mortality is disproportionately high in low-resource countries due to limited professional training and inadequate facilities.
- There is a significant research gap concerning pediatric mortality rates in low-income nations.
- This study addresses the need for data on pediatric perioperative mortality in such settings.
Purpose of the Study:
- To determine the incidence of perioperative pediatric mortality.
- To identify significant predictors of mortality within a 28-day follow-up period.
- To inform strategies for reducing pediatric deaths in resource-limited surgical environments.
Main Methods:
- A cohort of 1171 pediatric patients (0-17 years) undergoing surgery was studied from June 2019 to July 2021.
- Data were collected via REDCap, with analysis using STATA v.17.
- Bivariable and multivariable Cox regression analyses, including log-rank tests, were employed to assess survival and identify predictors.
Main Results:
- The overall perioperative mortality rate was 2.99% (35 deaths out of 1171 patients).
- The incidence rate was 1.11 deaths per 1000 person-days (95% CI: 0.79-1.54).
- Significant predictors included neonatal age (AHR=9.59), blood transfusion (AHR=2.6), and American Society of Anesthesiologists physical status III or higher (AHR=4.39).
Conclusions:
- Perioperative mortality in pediatric patients is notably high within 28 days post-surgery in this low-resource setting.
- Neonatal age, blood transfusion, and American Society of Anesthesiologists physical status III+ are critical predictors of mortality.
- Surgical teams must prioritize care for neonates, patients with ASA status III+, and those receiving transfusions to mitigate mortality risks.
Background:
Perioperative pediatric mortality is significantly higher in low-resource countries due to a scarcity of well-trained professionals and a lack of well-equipped pediatric perioperative services. There has been little research on pediatric mortality in low-income countries. Therefore, this study aimed to assess the incidence of perioperative pediatric mortality and its predictors in 28-day follow-up.
Methods:
The data were collected using REDCap, an electronic data collection tool, between June 01, 2019 and July 01, 2021. This study includes pediatric patients aged 0 to 17 years who underwent surgery in Tibebe Ghion Specialized Hospital over 28 days with a total of 1171 patients. STATA version 17 software was used for data analysis. Log-rank tests were fitted to explore survival differences. After bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported to declare the strength of association and statistical significance.
Results:
There were 35 deaths in the cohort of 1171 pediatric patients. Twenty of the deaths were in neonates. The overall perioperative mortality among pediatric patients was 2.99%, with an incidence rate of 1.11 deaths per 1000 person day observation (95% CI 0.79, 1.54). The neonatal age group had an AHR = 9.59, 95% CI 3.77, 24.3), transfusion had an AHR = 2.6, 95% CI 1.11, 6.09), and the America Society of Anesthesiology physical status classification III and above had an AHR = 4.39, 95% CI 1.61, 11.9 were found the significant predictors of perioperative pediatric mortality.
Conclusions:
In this study, the perioperative mortality of pediatric patients was high in the 28-day follow-up. Neonatal age, transfusion, and America Society of Anesthesiology physical status III and above were significant predictors of pediatric mortality. Therefore, perioperative surgical teams should give special attention to neonates, the America Society of Anesthesiology physical status III and above, and transfusion to reduce pediatric mortality.
