Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries.
Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries.
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DOI：
10.1136/bmjgh-2016-000091
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发表时间：
2016
影响因子：
8.1
通讯作者：
GlobalSurg Collaborative
中科院分区：
文献类型：
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作者：
GlobalSurg Collaborative
儿童健康是全球卫生议程上的一个关键优先事项，但在资源匮乏的地区，为儿童提供基本和紧急手术的情况参差不齐。本研究旨在确定全球低收入国家急诊腹部儿科手术的死亡风险。多中心、国际、前瞻性、队列研究。在2014年7月至12月的2周期间，自行选择的进行急诊腹部手术的外科单位提交了16岁以下连续儿童的预定数据。联合国的人类发展指数（HDI）被用来对国家进行分层。主要结果指标为术后30天死亡率，采用多水平logistic回归分析。这项研究包括来自43个国家253个中心的1409名患者; 282名2岁以下儿童。 其中，265人（18.8%）来自低人类发展指数国家，450人（31.9%）来自中等人类发展指数国家，694人（49.3%）来自高人类发展指数国家。最常见的手术是阑尾切除术、小肠切除术、幽门环肌切开术和肠套叠矫正术。在调整患者和医院风险因素后，与高HDI国家相比，低HDI国家（调整后OR 7.14（95% CI 2.52至20.23），p<0.001）和中等HDI国家（4.42（1.44至13.56），p=0.009）的30天儿童死亡率显著较高，转化为每1000例手术多死亡40例。 与高人类发展指数国家相比，低人类发展指数国家和中等人类发展指数国家的急诊腹部手术后儿童的校正死亡率可能高达7倍。有效提供紧急基本手术应成为全球儿童健康议程的一个关键优先事项。NCT 02179112;预结果。
Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally. Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression. This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed. Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas. NCT02179112; Pre-results.