Mortality from Surgical Conditions in Children: An Insight from a Tertiary-Level Government Hospital in Bangladesh

Abstract

Aims: While the developed world has significantly reduced mortality from surgical conditions in children, there is lack of adequate data on the outcome of children’s surgical conditions in the developing world. This study aims at assessing the spectrum of mortalities from children’s surgical conditions in a low-middle income country (LMIC). Methods: Mortality data were collected for a period of 12 years (2008 to 2019) among 0 to12-year old children to analyse the diseases which had higher mortality trends, age -group specific mortality trends and categorize those according to body system. Results: Among a total of 30,301 admitted children, 1228 (4.05%) patients died. Among them 53.01% were neonates, 20.28% were infants and 26.71% were children.  Male to female ratio was 1.95:1. Mortality from neonatal surgical conditions was 24.21%. Infant mortality rate was 5.65% and child mortality rate was 1.41%. Neonatal surgical admission and mortality had a higher yearly trend. Anorectal malformation (ARM) was the most common cause of death (12.05%), followed by intestinal obstruction (11.40%) and gastroschisis (8.63%). Tracheo-oesophageal fistula/ oesophageal atresia (TOF/OA) had the highest mortality rate (83.33%), followed by gastroschisis (80.92%) and intestinal atresia (42.535) among the respective admissions. Other important causes of mortality were jejuno-ileal atresia (5.37%), trauma (5.05%), Hirschsprung disease (4.64%), intestinal perforation (4.48%), omphalocele (4.15%), burn (4.07%) and posterior urethral valves (PUV), 3.58%.   Conclusion: Overall mortality rate was much higher than developed countries and lower than some African countries. Neonatal mortality rate was very high and among them TOF/OA and gastroschisis had extremely high mortality rates.