Surgical Outcomes After Major Abdominal Surgery In Children: Can Post-Operative Morbidity Survey Determine Relevant Morbidity Domains?
Keywords:
Major abdominal surgery, children, morbidityAbstract
Introduction: Surgery is associated with considerable potential morbidity and mortality.
The study objective was to establish if the post-operative morbidity survey could determine morbidity domains that adversely affect surgical outcomes (in terms of length of hospital stay (LOHS) and mortality) after major abdominal surgery in children.
Materials and Methods: This was a one-year prospective cross-sectional study at Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State. Data was collected from 84 consecutive patients seen during the study period. Postoperative morbidity survey (POMS) data were taken on the 1st to the 5th day after surgery, analysed using the IBM Statistical Product and Service Solutions (SPSS) version 24.0.0 software and the statistical relationship between the 5th day POMS findings, LOHS and mortality determined with p-values ≤ 0.05 regarded as statistically significant.
Results: A total of 84 patients (60 males, 24 females with male: female ratio of 2.5:1) were studied with age range of 1 day to 17 years (median age of 8 years). Perforated typhoid ileitis was the most common diagnosis (19.0%). All had derangement in at least one of the POMS domains on the first post-operative day. Sixty-four patients (76.2%) had derangements in the fifth day POMS. Derangements in haematological and wound domains on the fifth post-operative day significantly affected LOHS (p = 0.001 and 0.003 respectively). Mortality occurred in four patients (4.8%). These had fifth day POMS derangement in infectious, gastrointestinal and wound domains and these significantly affected mortality (p = 0.033, 0.038 and 0.010 respectively).
Conclusion: Derangements in haematological and wound domains at fifth post-operative day are significantly associated with LOHS while derangements in infectious, gastrointestinal and wound domains at fifth post-operative day are significantly associated with mortality. Controlling these domains may improve surgical outcome.
References
REFERENCES
Dirmick JB, Birkemeyer JD. Measuring the Quality of Surgical Care. In: Mulholland MW, Lillemoe KD, Doherty GM, Maier RV, Upchurch GR, editors. Greenfield’s surgery: scientic principles and practice. 5th edition. New York: Lippincott Williams and Wilkins, 2011. p. 291-7.
Weiser TG. Surgical capacity indicators in 2018 and beyond. Update in Anaesthesia. 2019;33(1):9-10.
Helkin A, Jain SV, Gruessner A, Fleming M, Kohman L, Costanza M et al. Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis. Perioper Med 2017;6(1):23-9.
Richards CH, Leitch FE, Horgan PG, Mcmillan DC. A Systematic Review of POSSUM and its Related Models as Predictors of Post-operative Mortality and Morbidity in Patients Undergoing Surgery for Colorectal Cancer. Journal of Gastrointestinal Surgery. 2010;14(10):1511-20.
Davies SJ, Francis J, Dilley J, Wilson RJT, Howell SJ, Allgar V. Measuring outcomes after major abdominal surgery during hospitalization: reliability and validity of the Postoperative Morbidity Survey. Perioper Med. 2013;2(1):14-20.
Bolliger M, Kroehnert JA, Molineus F, Kandioler D, Schindl M, Riss P. Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients. Eur. Surg. 2018;4(1):51-7.
Davies SJ, Francis J, Dilley J, Wilson RJT, Howell SJ, Allgar V. Measuring outcomes after major abdominal surgery during hospitalization: reliability and validity of the Postoperative Morbidity Survey. Periop Med. 2013;2(1):10-68.
Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg. 2010;4(5):94-9.
Shah N, Hamilton M. Clinical review: Can we predict which patients are at risk of complications following surgery? Crit Care. 2013;17(1):86-94.
Mauramo E, Lalluka T, Manty M, Sumanen H, Pietilainen O, Lahelma E et al. Diagnosis-Specific Sickness Absence and Subsequent Common Mental Disorders: A Register-Linkage Cohort Study among Finnish Public Sector Employees. Int. J. Environ. Res. Public Health. 2020;17(3):782-8.
Constitution of the Federal Republic of Nigeria, Chapter IV: Fundamental Rights [internet]. Avaialable from: http://www.nigeria-law.org/ConstitutionOfTheFederalRepublicOfNigeria.html [last updated: 20 Aug 2008; cited: 14 Nov 2015].
Mekta N, Jaksic T. Nutritional support of the pediatric patient. In: Holcomb GW, Murphy JP, editors. Ashcraft’s Paediatric Surgery. 5th edition. Philadelphia, PA, USA: Saunders Elsevier. 2010. p. 19–20.
Sarmah H, Hazarika B. Importance of the size of Sample and its determination in the context of data related to the schools of greater Guwahati. Bulletin of the Gauhati University Mathematics Association. 2012;12(1):41-8.
Nuhu A, Dahwa S, Hamza A. Operative management of typhoid ileal perforation in children. Afr J Paediatr Surg. 2010;7(1):9–13.
University of Virginia Health System. “Helping abdominal surgery patients recover sooner.” ScienceDaily. ScienceDaily, 17 October 2013.
Madu PT. Paediatric surgery in Nigeria: past, present and future. Afr J Paediatr Surg. 2009;6(1):137–42.
Singh M, Ponniah M, Jacob KS. A nested case–control study to determine the incidence and factors associated with unanticipated admissions following day care surgery. Indian J Anaesth. 2016;60(11):833-7.
Goodman BA, Batterham AM, Kothmann E, Cawthorn L, Yates D, Melsom H et al. Validity of the Postoperative Morbidity Survey after abdominal aortic aneurysm repair—a prospective observational study. Periop Med. 2015;4(1):10–6.
Howes TE, Cook TM, Corrigan LJ, Dalton SJ, Richards SK, Peden CJ. Postoperative morbidity survey, mortality and length of stay following emergency laparotomy. Anaeasthesia. 2015;70(9):1020–7.
Salo M, Ohlsson B, Arnbjornsson E, Stenstrom P. Appendicitis in children from a gender perspective. Pediatr Surg Int. 2015;31(9):845–53.
Sankaran-Walters S, Macal M, Grishina I. Sex differences matter in the gut: effect on mucosal immune activation and inflammation. Biol Sex Differ. 2013;4(1):10–2.
Klein S, Flanagan K. Sex differences in immune responses. Nat Rev Immunol. 2016;16(1):626-38.
Abdul-Rahman L, Adeniran J, Olusanya A. Paediatric surgical emergencies in a north central Nigerian centre. Ann Paeditric Surg. 2012;8(2):25–8.
Chukwubuike KE, Nduagubam OC, Ndu IK, Odetunde OA, Ekenze SO, Eze TC et al. Paediatric abdominal surgical emergencies in Enugu, south east Nigeria: any change in pattern and outcome. Eur J Clin Biomed Sci. 2019;5(2):39–42.
Ademuyiwa AO, Bode CO, Adesanya OA, Elebute OA. Non-trauma related paedistric abdominal surgical emergencies in Lagos, Nigeria: epidemiology and indicators of survival. Niger Med J. 2012;53(2):76–9.
Zakir A, Abubakar U, Lawal US, Imrana H, Habibu IT, Hassan IH et al. The practice of Almajiri: prospect and socio-medical challenges in Northern part of Nigeria. J. Afr. Stud. Dev. 2014;6(7):128-31.
Usang UE, Inyang AW, Nwachukwu IE, Emehute JDC. Typhoid perforation in children: an unrelenting plague in developing countries. J Infect Dev Ctries. 2017;11(10):747-52.
Ahmed A, Dauda M, Garba S, Ukwenya Y. Emergency abdominal surgery in Zaria, Nigeria. SAJS. 2010;48(2):59–62.
Memon MA, Patel JL, Dhuware M. A study on acute surgical abdomen in paediatric age group. Int J Adv Med. 2016;3(4):808-12.
Abantanga FA, Nimako B, Amoah M. The range of abdominal surgical emergencies in children older than 1 year at the Komfo Anokye teaching hospital, Kumasi, Ghana. Ann Afr Med. 2009;8(1):236–42.
Kirchhelle C, Dyson ZA, Dougan G. A Biohistorical Perspective of Typhoid and Antimicrobial Resistance. CID. 2019;69(Suppl 5):388-94.
Osifo OD, Ogiemwonyi SO. Typhoid ileal peforation in children in Benin city. Afr J Paediatr Surg. 2010;7(2):96-100.
Ekpemo SC, Eleweke N. Childhood typhoid intestinal perforations in Aba, Nigeria. Am J Pediatr. 2018;4(4):110–3.
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