South African Paediatric Surgical Outcomes Study: a 14-day prospective, observational cohort study of paediatric surgical patients.

Adolescent Child Child, Preschool Cohort Studies Female General Surgery / statistics & numerical data Hospital Mortality Humans Incidence Infant Infant, Newborn Infections / complications Length of Stay Male Pediatrics / statistics & numerical data Postoperative Complications / epidemiology Prospective Studies Risk Factors South Africa / epidemiology Treatment Outcome
anesthesiology developing countries hospital mortality outcome assessment (healthcare) pediatrics postoperative complications prospective studies specialties, surgical

Journal

British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541

Informations de publication

Date de publication:
Feb 2019
Historique:
received: 20 09 2018
revised: 29 10 2018
accepted: 17 11 2018
entrez: 29 1 2019
pubmed: 29 1 2019
medline: 4 4 2019
Statut: ppublish

Résumé

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). 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. 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. 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. NCT03367832.

Sections du résumé

BACKGROUND 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 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 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 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 BACKGROUND
NCT03367832.

Identifiants

DOI: 10.1016/j.bja.2018.11.015 PMID: 30686308
pubmed: 30686308
pii: S0007-0912(18)31331-X
doi: 10.1016/j.bja.2018.11.015
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT03367832']

Types de publication

Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

224-232

Investigateurs

K Allopi (K)
U Singh (U)
P Diyelela-Ndwandwa (P)
N Nongqo (N)
B Ravid (B)
P Anamourlis (P)
G Coetzee (G)
M Dlamini (M)
C Foster (C)
P Mogane (P)
D Nel (D)
A Oosthuizen (A)
L Redford (L)
R Murray (R)
C Basson (C)
J Joubert (J)
N Tshifularo (N)
T Els (T)
H Kluyts (H)
J Orrock (J)
M Muthambi (M)
T Matebesi (T)
G Tshukudu (G)
D Maela (D)
N Allorto (N)
J Bertie (J)
D Bishop (D)
K Chetty (K)
M Grobbelaar (M)
R Wise (R)
I von Steiger (I)
P Nundlal (P)
E Garoufalias (E)
G Westcott (G)
J Davids (J)
C Rajah (C)
R Rodseth (R)
C Cairns (C)
Y Mzoneli (Y)
K Bhagwan (K)
E Cloete (E)
B Biccard (B)
M Jaworska (M)
E Semenya (E)
O Porrill (O)
R Mungar (R)
P Seonandan (P)
N Perumal (N)
C Alphonsus (C)
M Bosman (M)
A De Castro (A)
L Drummond (L)
M Du Bruyn (M)
P Govender (P)
T Hardcastle (T)
Z Hlangu (Z)
P Jeena (P)
M Mbuyisa (M)
T Naidu (T)
J Sewlall (J)
J Taylor (J)
K Timakia (K)
A Torborg (A)
W Van der Walt (W)
T Biyase (T)
Z Khumalo (Z)
B Kusel (B)
I Mukama (I)
M Ramburuth (M)
S Singaram (S)
M Mbeki (M)
H Schutte (H)
P Anderson (P)
B Dorasamy (B)
P Kint (P)
S Goga (S)
L Cronjé (L)
N Dube (N)
S Jithoo (S)
L Naidoo (L)
L Naidu (L)
T Reddy (T)
Y Saman (Y)
D Rungan (D)
K Naidoo (K)
K Kabambi (K)
N Mgoqo (N)
M Mofoka (M)
B Mrara (B)
A Usenbo (A)
C Chiu (C)
N Machere (N)
D Maiwald (D)
G Davies (G)
T Serdyn (T)
P Gokal (P)
A Bhettay (A)
N Dhanjee (N)
H Meyer (H)
M Wege (M)
J Thomas (J)
S Govender (S)
S Tarr (S)
M Moodley (M)
M Balkisson (M)
A Maharaj (A)
S Ngcobo (S)
N Rorke (N)
S Sikhakhane (S)
M Khumalo (M)
T Ramsamy (T)
K Kabongo (K)
W Kuhn (W)
R Matos-Puig (R)
R Naidoo (R)
A Thotharam (A)
A Chohan (A)
S Adam (S)
I Appel (I)
A Burke (A)
C Cilliers (C)
C de Vos (C)
S Gautam (S)
E Joubert (E)
R Rautenbach (R)
D Roytowski (D)
A Szpytko (A)
E Brits (E)
B Diedericks (B)
G Naude (G)
J van Niekerk (J)
Z Fullerton (Z)

Informations de copyright

Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Auteurs

A Torborg (A)

Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa. Electronic address: alexandra@iafrica.com.

L Cronje (L)

Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa.

J Thomas (J)

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, South Africa; Division of Paediatric Anaesthesia, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa.

H Meyer (H)

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, South Africa; Division of Paediatric Anaesthesia, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa.

A Bhettay (A)

Department of Anaesthesia and Pain Medicine, Nelson Mandela Children's Hospital, University of the Witwatersrand, Johannesburg, South Africa.

J Diedericks (J)

Department of Anaesthesiology, University of the Free State, Bloemfontein, South Africa.

C Cilliers (C)

Department of Anaesthesiology and Critical Care, Stellenbosch University, Cape Town, South Africa.

H Kluyts (H)

Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.

B Mrara (B)

Department of Anaesthesia, Walter Sisulu University, Eastern Cape, South Africa.

M Kalipa (M)

Department of Anaesthesiology, University of Pretoria, Gauteng, South Africa.

R Rodseth (R)

Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa.

B Biccard (B)

Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, South Africa.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Enfant d'âge préscolaire › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Professions de santé › Médecine › Spécialités chirurgicales › Chirurgie générale › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Mortalité hospitalière › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › Incidence › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Infection › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Professions de santé › Médecine › Pédiatrie › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Régions géographiques › Afrique › Afrique subsaharienne › Afrique australe › République d'Afrique du Sud › South African Paediatric Surgical Outcomes...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › South African Paediatric Surgical Outcomes...