An analysis of neonatal mortality following gastro-intestinal and/or abdominal surgery in a tertiary hospital in South Africa
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In brief
In brief
Retrospective 12-year study of 762 neonates undergoing gastrointestinal/abdominal surgery at a South African tertiary hospital found 11% 30-day mortality, primarily from sepsis (74%). Necrotizing enterocolitis had highest mortality (28%), with prematurity present in 69% of deaths.
Written by the GCMD Library team from the article.
Abstract
Purpose
Thirty-day, 6-month and 12-month post-operative mortality and assessment of factors associated with 30 day post-operative mortality were ascertained.
Method
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.
Results
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%).
Conclusion
Mortality is double that of high-income countries, although significantly lower than most African settings. Strategic quality-improvement interventions are required to optimize outcomes.