Penn State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
Eastern Regional Hospital, P.O. Box 201, Koforidua, Ghana.
BMC Surg. 2020 Sep 22;20(1):211. doi: 10.1186/s12893-020-00867-9.
BACKGROUND/PURPOSE: Perioperative complications cause significant pediatric morbidity and mortality in low- and lower middle -income countries. This study investigates factors associated with prolonged length of stay, 90-day readmission and in-hospital mortality among pediatric patients at Eastern Regional Hospital (ERH) in Ghana.
This is a retrospective review of perioperative morbidity and mortality in children < 18 years at ERH in Koforidua, Ghana. All pediatric surgeries performed between January 2015 and December 2017 were included in this study. Univariate analysis was performed using Pearson's chi-square tests or Fisher's exact tests. Variables that were significant on univariate analysis were included in multivariable logistic regression models adjusted for age and gender.
We analyzed 468 patients < 18 years of age with a median length of stay (LOS) of 3 days. The 90-day readmission and in-hospital mortality rates were 138 and 17 per 1000 patients, respectively. The most common procedures were herniorrhaphy (19 %) and appendectomy (15 %). Gastrointestinal surgery, surgical trauma, surgical infection and lack of insurance were significantly associated with prolonged LOS. Young age and female gender were significantly associated with in-hospital mortality. Malaria was significantly associated with 90-day readmission.
Malaria infection is a significant risk factor for readmission, which should be investigated and treated in pediatric surgical patients in rural Ghana. Ensuring that all patients have insurance may result in shorter hospital stays. Provision of laparoscopic equipment may reduce hospital stays for patients undergoing gastrointestinal surgery. Expansion of the surgical work force, particularly pediatric surgeons, could improve perioperative survival in the very young population.
Retrospective comparative study.
背景/目的：围手术期并发症在中低收入国家导致了大量的儿科发病率和死亡率。本研究调查了加纳科福里杜亚东部地区医院（ERH）儿科患者中与住院时间延长、90 天再入院和院内死亡率相关的因素。
这是对 ERH 儿科患者围手术期发病率和死亡率的回顾性研究，年龄小于 18 岁。本研究纳入了 2015 年 1 月至 2017 年 12 月期间进行的所有儿科手术。使用 Pearson 卡方检验或 Fisher 精确检验进行单变量分析。单变量分析中具有统计学意义的变量纳入调整年龄和性别因素的多变量逻辑回归模型。
我们分析了 468 名年龄小于 18 岁的患者，中位住院时间（LOS）为 3 天。90 天再入院率和院内死亡率分别为每 1000 例患者 138 例和 17 例。最常见的手术是疝修补术（19%）和阑尾切除术（15%）。胃肠道手术、手术创伤、手术感染和没有保险与 LOS 延长显著相关。年龄较小和女性与院内死亡率显著相关。疟疾与 90 天再入院显著相关。
疟疾感染是再入院的一个重要危险因素，在加纳农村地区的儿科手术患者中应进行调查和治疗。确保所有患者都有保险可能会缩短住院时间。提供腹腔镜设备可能会减少接受胃肠道手术的患者的住院时间。扩大手术人员队伍，特别是儿科外科医生，可能会提高非常年轻人群的围手术期生存率。
回顾性比较研究。
