Predictors of Perioperative Mortality in Paediatric Surgery at a Tertiary Hospital in Sagamu, Nigeria

BackgroundThe burden of surgical diseases in children and perioperative complications in sub-Saharan Africa remains high. The assessment of the pattern and the determinants of perioperative mortality plays an invaluable role in identifying indicators of poor outcomes in order to improve overall outcomes in childrens surgery, thus necessitating this study. MethodsA retrospective review of medical records of patients aged 15 years and below, who had general pediatric, oncological, and urological surgeries under general anesthesia between January 2014 and December 2023, with complete records up to at least post-surgery or died within 30 days of surgery, was carried out. Information extracted included biodata, diagnosis, ASA classification of physical status, time of death after surgery, cause of death, and duration of surgery. Data were collated and analyzed using univariate and multivariate statistical tools. ResultsA total of 1621 patients were analyzed. The 30-day perioperative mortality rate in this study was 2.96% (296 per 10,000 patients); jejuno-ileal atresia, gastrochisis and bladder exstrophy are the conditions associated with the highest mortality rates, well above 50%. Furthermore, logistic regression model identified neonatal age group, ASA class greater than II and repeated surgical procedures as the significant predictors of mortality, while sepsis and intestinal/anastomosis failure were identified as the most common direct cause of death. ConclusionNeonatal age group, ASA class greater than II, and repeated surgery are the significant predictors of mortality in childrens surgery in our practice. Efforts should be made to combat sepsis and provide physiologic support and intensive care to improve outcomes. Key messagesWhat is already known about this subject: O_LIPerioperative mortality rate in pediatric surgery in sub-Saharan Africa remains high. C_LIO_LIOnly a few studies in the region have attempted to identify predictors of POM in children. C_LI What this study addsO_LIThis study revealed the real burden of POM in our practice and identified the determinants of poor outcomes C_LIO_LINeonatal age group, high ASA classification and repeated surgeries are significant predictors of mortality in this study C_LIO_LIJejuno-ileal atresia and gastrochisis are associated with a high case fatality rate. C_LI How this study might affect research, practice or policyO_LIFindings from this study provide potential tools to improve outcomes in pediatric surgery in the region. C_LI