Factors influencing the outcome of elective paediatric orthopaedic operations in Ile-Ife, Nigeria

Abstract

There is a paucity of published data on the types of paediatric orthopaedic conditions that require surgery and factors influencing their outcome in most parts of Sub-Saharan Africa. This is a necessary audit to improve paediatric orthopaedic practice. We carried out an audit of all elective orthopaedic operations performed in children at Awolowo University Teaching Hospitals Complex in Ile-Ife, Nigeria from January 2000 through December 2005. The aim was to document the clinical outcomes and the factors that influence them. This is with a view to instituting necessary measures to improve paediatric orthopaedic practice in the area. A total of 146 children who had elective operations on 210 limbs were included in the study. Their mean age was 75.6 +/- 66.8 months (range 0.3-396 months). The commonest indications for surgery were angular knee deformities (from Blount's disease and rickets) and club foot. The mean hospital stay before surgery was 12 +/- 8.8 days (range 1-38 days). The mean duration of operation was 78.4 +/- 36 min. (range 30-195 min). The total length of hospitalization was 34.97 +/- 19.91 days in males and 41.97 +/- 25.15 days in females. Wound infection was the commonest postoperative complication (8.2%). The patient's age (P = 0.002), indication for surgery (P = 0.008), length of preoperative hospital stay (P = 0.048), length of operation (P < 0.001) and intraoperative blood loss above 200ml (P < 0.001) were found to be statistically significant factors adversely affecting the surgical wound outcome. We conclude that most of the factors that predicted poor outcome in this study were patient and environment-related and are preventable. There is need to upgrade facilities in health institutions in Nigeria.