Pediatric perioperative mortality in Southeastern (SE) Nigeria—A multicenter, prospective study

Abstract

Background: The perioperative mortality rate is a key indicator of the quality of surgical services in low and middle-income countries (LMIC). Objective: To determine the perioperative mortality rate of pediatric surgical conditions and the predictive factors in Southeastern Nigeria. Methodology: A prospective, multicenter study of peri-operative mortalities occurring in children under 18 years in five tertiary hospitals in Southeastern Nigeria over nine months was conducted. All-cause and case-specific in-hospital peri-operative mortality rates, as well as predictive factors, were identified. The mortality rate was expressed as percentages with a 95% confidence interval. The data were analyzed using SPSS 26. Results: A total of 775 patients underwent anesthesia or surgery, with 28 deaths. The 30-day perioperative mortality rate was 3.61% (95% CI = 2.41- 5.18); 1.94% (95% CI = 1.09-3.17 within 24 hours, and 1.17% (95% CI = 0.91- 2.91) from 24 hours to 30 days after the procedure. The mortality rate was 100% for gastroschisis and ruptured omphalocele, with overwhelming sepsis being the major cause of death (53.6%). Significant determinants of mortality were a higher ASA status (AOR)=13.944, 95% CI=1.509-128.851, p=0.020, sedation without ventilatory support (AOR)=15.295, 95% CI=3.304-70.800, p=0.001, and associated comorbidities (AOR)=65.448, 95% CI=11.244-380.962, p=0.001. Conclusion: The pediatric peri-operative mortality rate in Southeastern Nigeria is high for gastroschisis. Associated comorbidities, higher ASA status, and sedation without ventilatory support were significant predictors of mortality.