Pediatric perioperative mortality in Southeastern Nigeria—a multicenter, prospective study

Abstract

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, and 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 perioperative mortality rates within 24 hours and 30 days after the procedure were 1.94% (95% CI = 1.09–3.17) and 1.17% (95% CI = 0.91–2.91) respectively. The mortality rates 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.