TY - JOUR
T1 - South African Paediatric Surgical Outcomes Study
T2 - a 14-day prospective, observational cohort study of paediatric surgical patients
AU - the South African Paediatric Surgical Outcomes Study Investigators
AU - Torborg, A.
AU - Cronje, L.
AU - Thomas, J.
AU - Meyer, H.
AU - Bhettay, A.
AU - Diedericks, J.
AU - Cilliers, C.
AU - Kluyts, H.
AU - Mrara, B.
AU - Kalipa, M.
AU - Rodseth, R.
AU - Biccard, B.
AU - Allopi, K.
AU - Singh, U.
AU - Diyelela-Ndwandwa, P.
AU - Nongqo, N.
AU - Ravid, B.
AU - Anamourlis, P.
AU - Coetzee, G.
AU - Dlamini, M.
AU - Foster, C.
AU - Mogane, P.
AU - Nel, D.
AU - Oosthuizen, A.
AU - Redford, L.
AU - Murray, R.
AU - Basson, C.
AU - Joubert, J.
AU - Tshifularo, N.
AU - Els, T.
AU - Orrock, J.
AU - Muthambi, M.
AU - Matebesi, T.
AU - Tshukudu, G.
AU - Maela, D.
AU - Allorto, N.
AU - Bertie, J.
AU - Bishop, D.
AU - Chetty, K.
AU - Grobbelaar, M.
AU - Wise, R.
AU - von Steiger, I.
AU - Nundlal, P.
AU - Garoufalias, E.
AU - Westcott, G.
AU - Davids, J.
AU - Rajah, C.
AU - Cairns, C.
AU - Mzoneli, Y.
AU - Bhagwan, K.
N1 - Publisher Copyright:
© 2018 British Journal of Anaesthesia
PY - 2019/2
Y1 - 2019/2
N2 - Background: Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs). Methods: We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications. Results: We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4–11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2–8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6–1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery. Conclusions: The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs. Clinical trial registration: NCT03367832.
AB - Background: Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs). Methods: We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications. Results: We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4–11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2–8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6–1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery. Conclusions: The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs. Clinical trial registration: NCT03367832.
KW - anesthesiology
KW - developing countries
KW - hospital mortality
KW - outcome assessment (healthcare)
KW - pediatrics
KW - postoperative complications
KW - prospective studies
KW - specialties, surgical
UR - http://www.scopus.com/inward/record.url?scp=85058533897&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2018.11.015
DO - 10.1016/j.bja.2018.11.015
M3 - Article
C2 - 30686308
AN - SCOPUS:85058533897
SN - 0007-0912
VL - 122
SP - 224
EP - 232
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 2
ER -