• A Torborg, L Cronje, J Thomas, H Meyer, A Bhettay, J Diedericks, C Cilliers, H Kluyts, B Mrara, M Kalipa, R Rodseth, B Biccard, and South African Paediatric Surgical Outcomes Study Investigators.
• 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.
• Br J Anaesth. 2019 Feb 1; 122 (2): 224-232.

BackgroundChildren 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).MethodsWe 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.ResultsWe 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.ConclusionsThe 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 RegistrationNCT03367832.Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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