Prospective, observational study of perioperative critical incidents, anaesthesia and mortality in elective paediatric surgical patients at a national referral hospital in Niger

Aims: To describe perioperative critical incidents, the conduct of anaesthesia and perioperative mortality in elective paediatric surgery patients in a national referral hospital in Niger. Methods: This is a prospective, observational study conducted from January to March 2018. All paediatric patients 15 years and younger, who underwent elective surgery in the Niamey National Hospital were included. The following variables were studied: age, sex, type of surgery, American Society of Anesthesiologists physical status (ASA PS) classification, monitoring system, anaesthesia technique, critical incidents, blood transfusion, analgesia, qualification of the anaesthesia practitioner, postoperative destination and mortality. Data were analysed with Excel 2007 and Epi Info 6 (TM) (Centers for Disease Control and Prevention Atlanta, GA). The chi(2) test was used for univariate associations with critical incidents. Statistical significance was considered if p < 0.05. Results: There were 231 (27.2%) paediatric patients of 849 surgical patients during the study period. Within the paediatric group, the mean age was 6 +/- 4 years. The male:female sex ratio was 1.65. A full blood count was completed preoperatively in all patients. Three per cent of the patients received a preoperative blood transfusion. The most frequently performed surgery was abdominal (42.4%). Most patients were classified as ASA PS I (55%) and ASA PS II (45%). General anaesthesia was performed in 96.1% of cases and spinal anaesthesia in 3.9%. The median duration of general anaesthesia was 63 (interquartile range 45-90) minutes. There were 27 reported critical incidents (11.7%), ten of which occurred during induction (4.9%), five intraoperatively (2.2%) and 12 postoperatively (5.2%). Multimodal postoperative analgesia was used in 33.8% of these patients. One patient died in the postoperative period (0.43%). Conclusion: Perioperative critical incidents in paediatric surgical patients in Niger remain high. To improve this situation requires paediatric training of anaesthetic staff, and improved paediatric monitoring and the use of safer anaesthesia agents.