Division of Paediatric Surgery at Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Rd, Rondebosch, Cape Town, 7700, South Africa.
Pediatr Surg Int. 2022 May;38(5):721-729. doi: 10.1007/s00383-022-05100-7. Epub 2022 Mar 2.
Thirty-day, 6-month and 12-month post-operative mortality and assessment of factors associated with 30 day post-operative mortality were ascertained.
A retrospective medical record audit for neonates who underwent gastrointestinal or abdominal wall surgery within the neonatal period at a tertiary free standing paediatric hospital during the 12-year period from 1 January 2007 to 31 December 2018.
The 30-day post-operative mortality rate was 83/762 (11%). Mortality resulted from: sepsis (74%), palliation due to ultra-short bowel length (12%), ventilation-associated pneumonia (10%), associated congenital cardiac lesions (3%) and intestinal failure-associated liver disease (1%). Surgery for necrotizing enterocolitis had the greatest 30-day post-operative mortality (28%). Most neonates (69%) who died were prematurely born. Mean age at surgery was ten days and mean age at death was six days. Abdominal compartment syndrome was noted post operatively in 15% patients. Risk factors for sepsis included central line-associated bloodstream infections (65%), respiratory tract infections (41%) and surgical complications [anastomotic breakdown (7%) and wound infection (24%)]. Mortality in patients from referral hospitals more than an hour's drive away was high (15/39, 38%).
Mortality is double that of high-income countries, although significantly lower than most African settings. Strategic quality-improvement interventions are required to optimize outcomes.
确定术后 30 天、6 个月和 12 个月的死亡率，并评估与术后 30 天死亡率相关的因素。
对 2007 年 1 月 1 日至 2018 年 12 月 31 日期间，在一家三级独立儿科医院新生儿期接受胃肠道或腹壁手术的新生儿进行回顾性病历审核。
术后 30 天死亡率为 83/762（11%）。死亡原因包括：败血症（74%）、超短肠长度姑息治疗（12%）、呼吸机相关性肺炎（10%）、合并先天性心脏病变（3%）和肠衰竭相关肝病（1%）。坏死性小肠结肠炎手术的术后 30 天死亡率最高（28%）。大多数死亡的新生儿（69%）为早产儿。手术时的平均年龄为 10 天，死亡时的平均年龄为 6 天。15%的患者术后出现腹腔间隔室综合征。败血症的危险因素包括中心静脉相关血流感染（65%）、呼吸道感染（41%）和手术并发症[吻合口破裂（7%）和伤口感染（24%）]。来自 1 小时车程以上转诊医院的患者死亡率较高（39 例中有 15 例，15/39，38%）。
尽管死亡率高于大多数非洲国家，但与高收入国家相比仍高出一倍。需要进行战略性的质量改进干预，以优化结果。
