Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries

GlobalSurg Collaborative

Abstract

Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.

Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.

Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.

Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.

Trial registration number: NCT02179112; Pre-results.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
World map showing participating countries and number of enrolled patients.
Figure 2
Figure 2
(A) Indications for emergency abdominal surgery in children across Human Developmental Index groups; (B) Surgical outcomes by Human Development Index group; (C) Adjusted 30-day mortality according to age groups. HDI, Human Developmental Index; SSI, surgical site infection.
Figure 3
Figure 3
Patient complications and mortality profile according to Human Development Index. HDI, Human Developmental Index; SSI, surgical site infection.

References

    1. Haynes AB, Weiser TG, Berry WR, et al. . A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360:491–9. 10.1056/NEJMsa0810119
    1. Tao W, Plecka-Ostlund M, Lu Y, et al. . Causes and risk factors for mortality within 1 year after obesity surgery in a population-based cohort study. Surg Obes Relat Dis 2015;11:399–405. 10.1016/j.soard.2014.08.015
    1. Iversen LH, Ingeholm P, Gögenur I, et al. . Major reduction in 30-day mortality after elective colorectal cancer surgery: a nationwide population-based study in Denmark 2001–2011. Ann Surg Oncol 2014;21:2267–73. 10.1245/s10434-014-3596-7
    1. Weiser TG, Regenbogen SE, Thompson KD, et al. . An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 2008;372:139–44. 10.1016/S0140-6736(08)60878-8
    1. Ameh EA, Dogo PM, Nmadu PT. Emergency neonatal surgery in a developing country. Pediatr Surg Int 2001;17:448–51. 10.1007/s003830000551
    1. Ademuyiwa AO, Sowande OA, Ijaduola TK, et al. . Determinants of mortality in neonatal intestinal obstruction in Ile Ife, Nigeria. Afr J Paediatr Surg 2009;6:11–13. 10.4103/0189-6725.48568
    1. Mouafo Tambo FF, Chiabi A, Ngowe Ngowe M, et al. . [Mortality of neonatal surgical emergencies at the gynecology-obstetric and pediatric hospital of Yaounde, Cameroon]. Med Trop (Mars) 2011;71:206–7.
    1. Ekenze SO, Ibeziako SN, Ezomike UO. Trends in neonatal intestinal obstruction in a developing country, 1996–2005. World J Surg 2007;31:2405–9. 10.1007/s00268-007-9206-0
    1. Osifo DO, Oriaifo IA. Factors affecting the management and outcome of neonatal surgery in Benin City, Nigeria. Eur J Pediatr Surg 2008;18:107–10. 10.1055/s-2008-1038485
    1. Keita M, Diallo MS, Keita AK, et al. . Newborn emergencies in the pediatric surgery service of CHU, Donka (Abstract). Mali Med 2006;21:16–20.
    1. Ameh EA, Seyi-Olajide JO, Sholadoye TT. Neonatal surgical care: a review of the burden, progress and challenges in sub-Saharan Africa. Paediatr Int Child Health 2015;35:243–51. 10.1179/2046905515Y.0000000033
    1. Ingraham AM, Cohen ME, Raval MV, et al. . Comparison of hospital performance in emergency versus elective general surgery operations at 198 hospitals. J Am Coll Surg 2011;212:20–8. 10.1016/j.jamcollsurg.2010.09.026
    1. Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 1996;25(4):835–9.
    1. Emergency General Surgery by Royal College of Surgeons of England (accessed 13 Apr 2016).
    1. Bhangu A, Fitzgerald JE, Fergusson S, et al. . Determining universal processes related to best outcome in emergency abdominal surgery: a multicentre, international, prospective cohort study. BMJ Open 2014;4:e006239 10.1136/bmjopen-2014-006239
    1. Harris PA, Taylor R, Thielke R, et al. . Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–81. 10.1016/j.jbi.2008.08.010
    1. Bhangu A, Fitzgerald JE, Kolias AG. Trainee-led research collaboratives: a novel model for delivering multi-centre studies. ANZ J Surg 2014;84:902–3. 10.1111/ans.12797
    1. Watters DA, Hollands MJ, Gruen RL, et al. . Perioperative Mortality Rate (POMR): a global indicator of access to safe surgery and anaesthesia. World J Surg 2015;39:856–64. 10.1007/s00268-014-2638-4
    1. Clavien PA, Barkun J, de Oliveira ML, et al. . The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187–96. 10.1097/SLA.0b013e3181b13ca2
    1. GlobalSurg Collaborative. Mortality of emergency abdominal surgery in high-, middle- and low-income countries. Br J Surg 2016;103:971–88.
    1. Ademuyiwa AO, Bode CO, Adesanya OA, et al. . Non trauma related abdominal surgical emergencies in Lagos: epidemiology and indicators of survival. Niger Med J 2012;53:76–9.
    1. Chao TE, Mandigo M, Opoku-Anane J, et al. . Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies. Surg Endosc 2016;30:1–10. 10.1007/s00464-015-4201-2
    1. Livingston MH, DCruz J, Pemberton J, et al. . Mortality of pediatric surgical conditions in low and middle income countries in Africa. J Pediatr Surg 2015;50:760–4. 10.1016/j.jpedsurg.2015.02.031.
    1. Shrime MG, Sleemi A, Ravilla TD. Charitable platforms in global surgery: a systematic review of their effectiveness, cost-effectiveness, sustainability, and role training. World J Surg 2015;39:10–20. 10.1007/s00268-014-2516-0
    1. Welling DR, Ryan JM, Burris DG, et al. . Seven sins of humanitarian medicine. World J Surg 2010;34:466–70. 10.1007/s00268-009-0373-z
    1. Riviello R, Ozgediz D, Hsia RY, et al. . Role of collaborative academic partnerships in surgical training, education and provision. World J Surg 2010;34:459–65. 10.1007/s00268-009-0360-4
    1. United Nations Sustainable Development Goals. Targets for Goal 3 (accessed 6 Aug 2016).
    1. World Health Organisation. World Health Assembly, 68/31. Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage 2015. (accessed 6 Aug 2016).

Source: PubMed

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