Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana

Abstract

Background/Purpose Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients at Eastern Regional Hospital (ERH) in Ghana. Methods This is a retrospective review of perioperative morbidity and mortality in children < 18 years at ERH in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study. Univariate analysis was performed using Pearson’s chi-square tests or Fisher’s exact tests. Variables that were significant on univariate analysis were included in multivariable logistic regression models adjusted for age and gender. Results We analyzed 468 patients < 18 years of age with a median length of stay (LOS) of 3 days. The 90-day readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19 %) and appendectomy (15 %). Gastrointestinal surgery, surgical trauma, surgical infection and lack of insurance were significantly associated with prolonged LOS. Young age and female gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. Conclusions Malaria infection is a significant risk factor for readmission, which should be investigated and treated in pediatric surgical patients in rural Ghana. Ensuring that all patients have insurance may result in shorter hospital stays. Provision of laparoscopic equipment may reduce hospital stays for patients undergoing gastrointestinal surgery. Expansion of the surgical work force, particularly pediatric surgeons, could improve perioperative survival in the very young population. Level of Evidence Retrospective comparative study.

Management Outcome and Factors Associated with Pediatric Surgical Patient Admitted to Arbaminch General Hospital, Southern Ethiopia, 2021: Retrospective Cross-Sectional Study

“…The current study found that children admitted for a trauma-related reason were more likely to have an unfavorable management outcome. This is consistent with the study done in Ghana [ 24 ], Nigeria [ 18 ], and Ethiopia [ 25 ]. This could be explained by the fact that trauma cases are more likely than other admissions to have complications like infection, hemorrhage, respiratory failure, renal failure, and sepsis, which complicate surgical cases by delaying wound healing and recovery time [ 26 ].…”

“…According to this study, children who received surgical management were almost twice more likely to be discharged with unfavorable management outcome when compared to their counterparts. This finding was supported by a study done in Ghana [ 24 ]. This could be explained by the fact that children who have had surgery are more likely to experience complications such as postoperative infection, hemorrhage, and wound dehiscence, all of which complicate the postoperative recovery phase.…”

“…This study found that having a preexisting medical condition at the time of admission was positively associated with unfavorable management outcome. A study conducted in Ghana and the Black Lion Hospital in Ethiopia were consistent with this finding [ 14 , 24 ]. This could be explained by the fact that patients with preexisting conditions have lower immune levels, which makes them more susceptible to infection, especially nosocomial infection, which prolongs hospital stays and delays the healing of wounds.…”

Paediatric urology inSub‐SaharanAfrica: challenges and opportunities

“…Malnutrition effects immunological function, tissue healing, and may result in sub‐optimal postoperative outcomes. Anaemia, associated with malnutrition, malaria, and HIV present additional difficulties especially when if blood donation is required [25].…”

Comment on: Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression

“…The number of cardiac arrests described was 150, but the correct number of cardiac arrests in children was 50, as described in the article. Peiffer et al [ 15 ]. The accurate year of publication is 2020, not 2018.…”