Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Sub-Saharan Africa

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 in eastern Ghana. Methods This is a retrospective review of perioperative morbidity and mortality in children <18 years at Eastern Regional Hospital (ERH) in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study and secondary analysis was performed. Results We analyzed 468 patients <18 years of age with a median length of stay (LOS) of 3 days. The readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19%) and appendectomy (15%). Major procedures, gastrointestinal surgery, surgical trauma, surgical infection and having insurance were significantly associated with prolonged LOS. Age and male gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission. Conclusions Malaria infection is a significant and actionable risk factor for readmission in the pediatric surgical population in sub-Saharan Africa. Preventing readmission in patients with malaria could reduce readmission rates by 74%, leading to potential cost-savings and reductions in morbidity.

A Three-year Retrospective Study of Perioperative Mortality at a Tertiary Children Hospital in Iran

“…In a multicenter, cohort study in low-income countries to measure 30-day postoperative mortality in children aged < 16 years, sex of patients was not determined as a predictor of mortality (14). In contrast to the present study, a signi cant relationship between female sex and perioperative mortality was found in a study conducted in Ghana (15). In a study in California (16), individuals < 21 years old who had cardiac surgery were selected to evaluate the role of gender in cardiovascular outcomes.…”