Global neonatal perioperative mortality: A systematic review and meta-analysis
Leandro G Braz1, Jose Reinaldo C Braz1, Teofilo Augusto A Tiradentes1
1Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.
Insights
Neonatal perioperative mortality rates (POMR) are high globally. This review found significantly higher 24-hour and 30-day POMRs in low Human Development Index (HDI) countries compared to higher HDI nations.
Area of Science:
- Global health
- Surgical outcomes
- Neonatal care
Background:
- Perioperative mortality rate (POMR) in neonates is a recognized global concern, exceeding rates in older populations.
- Significant disparities in healthcare exist across countries, impacting surgical outcomes.
Purpose of the Study:
- To systematically review and meta-analyze published 24-hour and 30-day POMRs in neonates.
- To compare POMRs across countries with varying Human Development Index (HDI) levels between 2011 and 2022.
Main Methods:
- Systematic review and meta-analysis of studies reporting neonatal POMRs.
- Data collected from January 2011 to July 2022.
- Analysis of POMRs per 10,000 procedures under anesthesia, categorized by country HDI levels.
Main Results:
- Eighteen studies from 45 countries were included, analyzing 33,729 anesthetic procedures.
- Low-HDI countries showed significantly higher 24-hour POMRs compared to very-high-, high-, and medium-HDI countries.
- Low-HDI countries also exhibited higher 30-day POMRs compared to very-high-HDI countries.
Conclusions:
- Global POMRs in neonates undergoing surgery are notably high, irrespective of country HDI.
- Significant differences in 24-hour and 30-day POMRs were observed between low-HDI and higher-HDI countries.
Study Objective:
There are large differences in health care among countries. A higher perioperative mortality rate (POMR) in neonates than in older children and adults has been recognized worldwide. The aim of this study was to provide a systematic review of published 24-h and 30-day POMRs in neonates from 2011 to 2022 in countries with different Human Development Index (HDI) levels.
Design And Setting:
A systematic review with a meta-analysis of studies that reported 24-h and 30-day POMRs in neonates was performed. We searched the databases from January 2011 to July 30, 2022.
Measurements:
The POMRs (per 10,000 procedures under anesthesia) were analyzed according to country HDI. The HDI levels ranged from 0 to 1, representing the lowest and highest levels, respectively (very-high-HDI: ≥ 0.800, high-HDI: 0.700-0.799, medium-HDI: 0.550-0.699, and low-HDI: < 0.550). The magnitude of the POMRs by country HDI was studied using meta-analysis.
Main Results:
Eighteen studies from 45 countries were included. The 24-h (n = 96 deaths) and 30-day (n = 459 deaths) POMRs were analyzed from 33,729 anesthetic procedures. The odds ratios (ORs) of the 24-h POMR in low-HDI countries were higher than those in very-high- (OR 8.4, 95% CI 1.7-40.4; p = 0.008), high- (OR 7.3, 95% CI 2.2-24.4; p = 0.001) and medium-HDI countries (OR 7.7, 95% CI 3.1-18.7; p < 0.0001) but with no odds differences between very-high- and high-HDI countries (p = 0.879), very-high- and medium-HDI countries (p = 0.915) and high- and medium-HDI countries (p = 0.689). The odds of a 30-day POMR in low-HDI countries were higher than those in very-high-HDI countries (OR 6.9, 95% CI 1.9-24.6; p = 0.002) but not in high-HDI countries (OR 1.4, 95% CI 0.6-3.0; p = 0.396).
Conclusions:
The review demonstrated very high global POMRs in a surgical population of neonates independent of the country HDI level. We identified differences in 24-h and 30-day POMRs between low-HDI countries and other countries with higher HDI levels.
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