{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:43:27Z","timestamp":1786653807768,"version":"build-2736575974"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The perioperative mortality rate is a key indicator of the quality of surgical services in low and middle-income countries (LMIC). Objective: To determine the perioperative mortality rate of pediatric surgical conditions and the predictive factors in Southeastern Nigeria. Methodology: A prospective, multicenter study of peri-operative mortalities occurring in children under 18 years in five tertiary hospitals in Southeastern Nigeria over nine months was conducted. All-cause and case-specific in-hospital peri-operative mortality rates, as well as predictive factors, were identified. The mortality rate was expressed as percentages with a 95% confidence interval. The data were analyzed using SPSS 26.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 775 patients underwent anesthesia or surgery, with 28 deaths. The 30-day perioperative mortality rate was 3.61% (95% CI = 2.41- 5.18); 1.94% (95% CI = 1.09-3.17 within 24 hours, and 1.17% (95% CI = 0.91-2.91) from 24 hours to 30 days after the procedure. The mortality rate was 100% for gastroschisis and ruptured omphalocele, with overwhelming sepsis being the major cause of death (53.6%). Significant determinants of mortality were a higher ASA status (AOR)=13.944, 95% CI=1.509-128.851, p=0.020, sedation without ventilatory support (AOR)=15.295, 95% CI=3.304-70.800, p=0.001, and associated comorbidities (AOR)=65.448, 95% CI=11.244-380.962, p=0.001.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The pediatric peri-operative mortality rate in Southeastern Nigeria is high for gastroschisis. Associated comorbidities, higher ASA status, and sedation without ventilatory support were significant predictors ofmortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/njcp.njcp_695_24","type":"journal-article","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T00:46:54Z","timestamp":1743295614000},"page":"225-231","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Pediatric Perioperative Mortality in Southeastern (SE) Nigeria\u2014A Multicenter, Prospective Study"],"prefix":"10.4103","volume":"28","author":[{"given":"EP","family":"Nwankwo","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, College of Medicine, University of Nigeria Nsukka, Enugu State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DC","family":"Onyejesi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, College of Medicine, University of Nigeria Nsukka, Enugu State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"IS","family":"Chukwu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Federal Medical Center, Umuahia, Abia State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"VI","family":"Modekwe","sequence":"additional","affiliation":[{"name":"Department of Surgery, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"EI","family":"Nwangwu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, College of Medicine, University of Nigeria Nsukka, Enugu State, Nigeria"},{"name":"Department of Surgery, Federal Medical Center, Owerri, Imo State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"UO","family":"Ezomike","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, College of Medicine, University of Nigeria Nsukka, Enugu State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SE","family":"Omebe","sequence":"additional","affiliation":[{"name":"Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SO","family":"Ekenze","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, College of Medicine, University of Nigeria Nsukka, Enugu State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SC","family":"Aliozor","sequence":"additional","affiliation":[{"name":"Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"EC","family":"Aniwada","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"R1-20260423","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1016\/S2214-109X(15)70087-2","article-title":"Estimated need for surgery worldwide based on prevalence of diseases: A modelling strategy for the WHO Global Health Estimate","volume":"3","author":"Rose","year":"2015","journal-title":"Lancet Glob Health"},{"key":"R2-20260423","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1007\/s00268-012-1482-7","article-title":"Challenges of surgery in developing countries: A survey of surgical and anesthesia capacity in Uganda\u2019s public hospitals","volume":"36","author":"Linden","year":"2012","journal-title":"World J Surg"},{"key":"R3-20260423","first-page":"829","article-title":"Surgical services for children in developing countries","volume":"80","author":"Bickler","year":"2002","journal-title":"Bull the World Health Org"},{"key":"R4-20260423","doi-asserted-by":"crossref","first-page":"e000810.","DOI":"10.1136\/bmjgh-2018-000810","article-title":"Perioperative mortality rates in low-income and middle-income countries: A systematic review and meta-analysis","volume":"3","author":"Ng-Kamstra","year":"2018","journal-title":"BMJ Glob Health"},{"key":"R5-20260423","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/S0140-6736(15)60160-X","article-title":"Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development","volume":"386","author":"Meara","year":"2015","journal-title":"Lancet"},{"key":"R6-20260423","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1093\/bja\/aev286","article-title":"Perioperative hospital mortality at a tertiary paediatric institution","volume":"115","author":"de Bruin","year":"2015","journal-title":"Br J Anaesth"},{"key":"R7-20260423","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1007\/s00268-014-2638-4","article-title":"Perioperative mortality rate (POMR): A global indicator of access to safe surgery and anaesthesia","volume":"39","author":"Watters","year":"2015","journal-title":"World J Surg"},{"key":"R8-20260423","doi-asserted-by":"crossref","first-page":"101","DOI":"10.22514\/SV121.102016.17","article-title":"Unreported deaths in pediatric surgery and anesthesia: A national, twenty-year report","volume":"12","author":"Putzu","year":"2016","journal-title":"Signa Vitae"},{"key":"R9-20260423","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.jpedsurg.2018.06.026","article-title":"24-hour and 30-day perioperative mortality in pediatric surgery","volume":"54","author":"Bonasso","year":"2019","journal-title":"J Pediatr Surg"},{"key":"R10-20260423","doi-asserted-by":"crossref","first-page":"e000237.","DOI":"10.1136\/wjps-2020-000237","article-title":"Perioperative mortality in children in a tertiary teaching hospital in Nigeria: A prospective study","volume":"4","author":"Talabi","year":"2021","journal-title":"World J of Pediatr Surg"},{"key":"R11-20260423","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1097\/ALN.0000000000003070","article-title":"Pediatric perioperative mortality in Kenya: A prospective cohort study from 24 hospitals","volume":"132","author":"Newton","year":"2020","journal-title":"Anesthesiology"},{"key":"R12-20260423","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/S0140-6736(21)00767-4","article-title":"Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: A multicentre, international, prospective cohort study","volume":"398","author":"Wright","year":"2021","journal-title":"Lancet"},{"key":"R13-20260423","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s00383-020-04638-8","article-title":"Major abdominal wall defects in the low- and middle-income setting: Current status and priorities","volume":"36","author":"Anyanwu","year":"2020","journal-title":"Pediatr Surg Int"},{"key":"R14-20260423","doi-asserted-by":"crossref","first-page":"1504.","DOI":"10.3390\/children9101504","article-title":"Improved mortality of patients with gastroschisis: A historical literature review of advances in surgery and critical care from 1960\u20132020","volume":"9","author":"Georgeades","year":"2022","journal-title":"Children"},{"key":"R15-20260423","doi-asserted-by":"crossref","first-page":"36.","DOI":"10.4103\/jiaps.JIAPS_30_18","article-title":"A pilot study on neonatal surgical mortality: A multivariable analysis of predictors of mortality in a resource-limited setting","volume":"24","author":"Puri","year":"2019","journal-title":"J Indian Assoc Pediatr Surg"},{"issue":"137","key":"R16-20260423","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1097\/ALN.0000000000004369","article-title":"Perioperative mortality in pediatric patients: A systematic review of risk assessment tools for use in the preoperative setting","volume":"1","author":"Tangel","year":"2022","journal-title":"Anesthesiology"},{"key":"R17-20260423","doi-asserted-by":"crossref","first-page":"15.","DOI":"10.3389\/fsurg.2022.817528","article-title":"Neonatal surgical morbidity and mortality at a single tertiary center in a low-and middle-income country: A retrospective study of clinical outcomes","volume":"9","author":"Hasan","year":"2022","journal-title":"Front Surg"},{"key":"R18-20260423","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1016\/j.jpedsurg.2020.05.035","article-title":"Risk factors of early mortality after neonatal surgery in Tunisia","volume":"55","author":"Ammar","year":"2020","journal-title":"J Pediatr Surg"},{"key":"R19-20260423","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/S0022-3468(03)00184-2","article-title":"Neonatal surgery in New South Wales\u2014What is performed where?","volume":"38","author":"Badawi","year":"2003","journal-title":"J Pediatr Surg"},{"key":"R20-20260423","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1007\/s00383-015-3775-z","article-title":"Twenty-year trends in neonatal surgery based on a nationwide Japanese surveillance program","volume":"31","author":"Yagi","year":"2015","journal-title":"Pediatr Surg Int"},{"key":"R21-20260423","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1016\/j.jpedsurg.2016.02.084","article-title":"Does the american college of surgeons national surgical quality improvement program pediatric provide actionable quality improvement data for surgical neonates?","volume":"51","author":"Bucher","year":"2016","journal-title":"J Pediatr Surg"},{"key":"R22-20260423","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/S0022-3468(96)90340-1","article-title":"Prenatal diagnosis and the pediatric surgeon: The impact of prenatal consultation on perinatal management","volume":"31","author":"Crombleholme","year":"1996","journal-title":"J Pediatr Surg"},{"key":"R23-20260423","doi-asserted-by":"crossref","first-page":"1328796.","DOI":"10.1080\/16549716.2017.1328796","article-title":"Effectiveness of antenatal care services in reducing neonatal mortality in Kenya: Analysis of national survey data","volume":"10","author":"Arunda","year":"2017","journal-title":"Glob Health Action"},{"key":"R24-20260423","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.jpedsurg.2015.02.031","article-title":"Mortality of pediatric surgical conditions in low- and middle-income countries in Africa","volume":"50","author":"Livingston","year":"2015","journal-title":"J Pediatr Surg"},{"key":"R25-20260423","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/j.jsps.2022.05.002","article-title":"Sedation level with midazolam: A pediatric surgery approach","volume":"30","author":"Flores-P\u00e9rez","year":"2022","journal-title":"Saudi Pharm J"},{"key":"R26-20260423","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1097\/ALN.0000000000002659","article-title":"Pediatric risk stratification is improved by integrating both patient comorbidities and intrinsic surgical risk","volume":"130","author":"Nasr","year":"2019","journal-title":"Anesthesiology"},{"key":"R27-20260423","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1213\/ANE.0000000000005924","article-title":"Access to safe pediatric anesthesia in LMICs\u2014the problem is clear; it is time to solve it!","volume":"134","author":"Evans","year":"2022","journal-title":"Anesth Analg"}],"container-title":["Nigerian Journal of Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/njcp.njcp_695_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:42:30Z","timestamp":1786650150000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/njcp.njcp_695_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":27,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/njcp.njcp_695_24","relation":{},"ISSN":["1119-3077","2229-7731"],"issn-type":[{"value":"1119-3077","type":"print"},{"value":"2229-7731","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]},"assertion":[{"value":"2024-10-11","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-23","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}