Current Landscape of Children's Surgery in Africa: A Multicenter Analysis of 16,000 Cases.

Abstract

Background: Although prior studies have estimated the burden of pediatric surgical disease in low- and middle-income countries (LMICs) through statistical modeling and hospital- or household-based surveys, few large-scale descriptions of procedures and outcomes have been published. We aimed to describe the epidemiology and outcomes of children's surgical care at multiple centers across Africa.

Methods: Perioperative clinical data were collected prospectively from 2018 to 2023 at 17 hospitals in 11 African countries using a preexisting tool. Data came from children (age < 18 years) who underwent a surgical procedure in facilities equipped by the NGO Kids Operating Room. Data were stored on REDCap and descriptively analyzed.

Results: 16,454 procedures were performed, with a higher frequency of procedures performed in younger children than in older children (mean age 4.5 years). Congenital malformations, acquired genitourinary conditions, and acquired gastrointestinal conditions made up the most common diagnoses. We found a mortality rate of 3.7%, with higher mortality in neonates compared to younger children; conditions associated with the greatest mortality included congenital conditions, intestinal perforation, burns, and intussusception. Emergent operations were associated with much higher rates of mortality than elective operations.

Conclusions: For the first time at this scale, we have assessed the epidemiology and outcomes of pediatric surgical care in LMICs. Findings were consistent with studies on the burden of disease, with a larger proportion of younger children accessing surgery, comparable mortality to other African studies, and higher mortality than in HICs. Future research and multilevel advocacy are needed to identify gaps in care and to design more effective interventions to reduce global disparities in access to surgical care for children.