28-day perioperative pediatric mortality and its predictors in a tertiary teaching hospital in Ethiopia: a prospective cohort study

Abstract

BackgroundPerioperative pediatric mortality is significantly higher in low-resource countries due to a scarcity of well-trained professionals and a lack of well-equipped pediatric perioperative services. There has been little research on pediatric mortality in low-income countries. Therefore, this study aimed to assess the incidence of perioperative pediatric mortality and its predictors in 28-day follow-up.MethodsThe data were collected using REDCap, an electronic data collection tool, between June 01, 2019 and July 01, 2021. This study includes pediatric patients aged 0 to 17 years who underwent surgery in Tibebe Ghion Specialized Hospital over 28 days with a total of 1171 patients. STATA version 17 software was used for data analysis. Log-rank tests were fitted to explore survival differences. After bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported to declare the strength of association and statistical significance.ResultsThere were 35 deaths in the cohort of 1171 pediatric patients. Twenty of the deaths were in neonates. The overall perioperative mortality among pediatric patients was 2.99%, with an incidence rate of 1.11 deaths per 1000 person day observation (95% CI 0.79, 1.54). The neonatal age group had an AHR = 9.59, 95% CI 3.77, 24.3), transfusion had an AHR = 2.6, 95% CI 1.11, 6.09), and the America Society of Anesthesiology physical status classification III and above had an AHR = 4.39, 95% CI 1.61, 11.9 were found the significant predictors of perioperative pediatric mortality.ConclusionsIn this study, the perioperative mortality of pediatric patients was high in the 28-day follow-up. Neonatal age, transfusion, and America Society of Anesthesiology physical status III and above were significant predictors of pediatric mortality. Therefore, perioperative surgical teams should give special attention to neonates, the America Society of Anesthesiology physical status III and above, and transfusion to reduce pediatric mortality.