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Updated: May 8, 2026
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Delayed primary surgery and outcomes in children with gastrointestinal anomalies in 264 hospitals and 74 countries
Kelsey R Landrum1,2, Brian W Pence1, Mark G Shrime3,4
1Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
Insights
Delayed surgery for congenital gastrointestinal anomalies increases mortality and complications in children, especially in low-income countries. Prompt surgical intervention is crucial for better outcomes in these vulnerable pediatric patients.
Area of Science:
- Pediatric Surgery
- Global Health
- Congenital Anomalies
Background:
- Delayed presentation to primary surgery for congenital gastrointestinal anomalies is a significant concern.
- Outcomes related to delayed surgical intervention in pediatric patients remain poorly understood globally.
Purpose of the Study:
- To assess predictors of delayed presentation to primary surgery in children with gastrointestinal anomalies.
- To compare 30-day mortality and complication risks between delayed and non-delayed surgical presentation.
Main Methods:
- A cohort study of 3767 children with gastrointestinal anomalies across 74 countries (2018-2019).
- Analysis of predictors for delayed presentation (>24 hours of life) versus timely presentation (<=24 hours of life).
- Comparison of 30-day all-cause mortality (ACM) and complication risks.
Main Results:
- Children in low- and middle-income countries (LMICs) had a higher probability of delay and increased mortality risk compared to high-income countries (HICs).
- Delayed presentation was associated with greater 30-day ACM risk for gastroschisis, omphalocele, intestinal atresia, and esophageal atresia.
- Delayed presentation also increased complication risk for gastroschisis and esophageal atresia.
Conclusions:
- Delayed surgical presentation significantly elevates mortality and complication risks in pediatric patients with gastrointestinal anomalies.
- Disparities exist, with higher delay probabilities and mortality risks observed in LMICs.
- Timely surgical intervention is critical for improving outcomes in children with these congenital conditions.
Abstract:
The impact of delayed presentation to primary surgery on mortality and complication outcomes in children with gastrointestinal congenital anomalies is poorly understood. Using a cohort of 3767 children with gastrointestinal anomalies in 74 countries (2018-2019), we assessed predictors of delay and compare 30-day risk of all-cause mortality (ACM) and complication among children with delayed ($>$24 hours of life) versus non-delayed ($\le$24 of life) presentation to primary surgery. Children in low-and middle-income countries (LMICs) had greater probability of delay (PR: 1.79; 95% CI: 1.59, 2.02) and mortality risk for all anomaly types compared to children in high-income countries (HICs). Compared to non-delayed children, delayed children with gastroschisis (RR: 1.62; 1.07, 2.47), omphalocele (RR: 1.17; 0.62, 2.21), intestinal atresia (RR: 1.88; 1.34, 2.63), and esophageal atresia (1.54; 1.15, 2.05) had greater ACM risk. Delayed children with gastroschisis (1.48; 1.25, 1.75) and esophageal atresia (1.17; 1.05, 1.30) had greater complication risk. Probability of delay and risk of death was higher in LMICs than HICs. Compared to non-delayed children, delayed children with gastroschisis, omphalocele, intestinal atresia, and esophageal atresia had greater 30-day ACM risk and delayed children with gastroschisis and esophageal atresia had greater 30-day complication risk.
