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Perioperative mortality in pediatric non-cardiac surgery in Ethiopia: a systematic review and meta-analysis
Sitotaw Tesfa Zegeye1, Eshetu Tesfaye Dejen1, Meseret Hulualem Nega1
1Bahir Dar University, Bahir Dar, Ethiopia.
Insights
Perioperative pediatric mortality in Ethiopia is high, affecting 15.81% of children. Key risk factors include emergency and neonatal surgeries, delayed presentation, and prolonged hospital stays.
Area of Science:
- Global Health
- Pediatric Surgery
- Public Health
Background:
- Perioperative mortality in children remains a significant concern, with rates substantially higher than in adults.
- Despite advancements in anesthesia and surgical care, pediatric perioperative mortality persists as a critical issue.
- Evidence regarding perioperative pediatric mortality in Ethiopia is limited, necessitating focused research.
Purpose of the Study:
- To systematically review and analyze existing literature on perioperative pediatric mortality in Ethiopia.
- To generate robust evidence on the incidence and predictors of perioperative pediatric mortality in the Ethiopian context.
- To inform public health strategies and improve surgical outcomes for children in Ethiopia.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
- Comprehensive literature search across PubMed, African Journals Online, Cochrane Library, and CINAHL for English-language studies.
- Methodological quality appraisal using Joanna Briggs Institute tools and data analysis with Stata 17.
Main Results:
- Analysis included 23 studies with 7,059 pediatric participants.
- The pooled incidence of perioperative pediatric mortality was 15.81% (95% CI: 11.82-19.79).
- Significant predictors of mortality included neonatal surgery (pOR=8.65), pediatric trauma surgery (pOR=8.07), delayed presentation (pOR=4.41), prolonged hospital stays (pOR=3.46), and emergency surgery (pOR=2.35).
Conclusions:
- Perioperative pediatric mortality in Ethiopia is notably elevated.
- Neonatal surgery, pediatric trauma surgery, delayed presentation, prolonged hospital stays, and emergency surgery are significant risk factors.
- Findings underscore the need for targeted interventions to reduce pediatric mortality in Ethiopian surgical settings.
Background:
Perioperative mortality in children continues to be a major concern, with rates significantly exceeding those observed in adults. This issue remains despite improvements in anesthesia, surgical, and perioperative management. The aim of this systematic review and meta-analysis is to generate evidence regarding perioperative pediatric mortality in Ethiopia.
Methods:
This systematic review was conducted in strict adherence to the PRISMA 2020 guidelines. A thorough literature search was undertaken to identify published and unpublished English-language studies. Electronic databases, including PubMed, African Journals Online, Cochrane Library, and CINAHL, were systematically searched to capture relevant studies for inclusion. The methodological quality of the selected studies was appraised using the Joanna Briggs Institute critical appraisal tools. Data analysis was performed using Stata version 17, whereby the pooled incidence of perioperative pediatric mortality was calculated, and potential predictors were examined.
Results:
A total of 23 studies, comprising 7,059 participants, were included in this analysis. The pooled incidence of perioperative pediatric mortality was found to be 15.81% (95%CI: 11.82-19.79). Factors significantly associated with elevated perioperative pediatric mortality included neonatal surgery (pOR = 8.65; 95%CI: 4.06-18.45), pediatric trauma surgery (pOR = 8.07; 95%CI: 4.66-13.98), delayed presentation and surgical intervention following the onset of disease (pOR = 4.41; 95%CI: 2.02-9.62), prolonged hospital stays (pOR = 3.46; 95%CI: 2.10-5.68), and emergency surgery (pOR = 2.35; 95%CI: 1.80-3.08).
Conclusion:
The meta-analysis indicates that perioperative pediatric mortality in Ethiopia is elevated. Significant factors include pediatric trauma surgery, emergency surgery, delayed presentation and intervention following disease onset, prolonged hospital stay, and neonatal surgery.
