Latin American Surgical Outcomes Study in Pediatric Patients

Background

Surgery is a cost-effective public health intervention. However, there are significant disparities in access to and in the safety of surgical and anesthesia services in low- and middle-income countries compared to high-income countries. (1) Additionally, there is a significant burden of surgical disease in the pediatric surgical population with a significant unmet need. (2,3) In Africa, children represent a significant proportion of the population, with approximately 50% of the population aged <19 years; moreover, this proportion is very similar in Latin America. (4) Postoperative complications are an important determinant of surgical morbidity and mortality. Limited data from Africa and Latin America suggest that risk factors, incidence, and outcomes associated with pediatric surgical complications differ in high-income countries. In the South African Pediatric Surgical Outcomes Study (SAPSOS), patients in this middle-income country (5) had twice the incidence of complications (6-8), and the types of complications differed from those in high-income countries, with a predominance of infectious complications. Furthermore, risk factors for complications (including ASA physical status, urgent surgery, surgery severity, and infectious indication for surgery) were different from those in high-income countries, wherein the risk factors include post-conceptual age, ASA physical status > 3, history of cardiovascular disease, and cardiovascular, neurological, or orthopedic surgical procedures. (9) Postoperative mortality was observed to be ten times higher in

South Africa than in a prospective study in high-income countries. (10) Furthermore, a prospective study of pediatric perioperative mortality in 24 Kenyan hospitals demonstrated a 7-day postoperative mortality of 1.7% (11), which is 17 times higher than that reported in high-income countries.

The African Surgical Outcomes Study (ASOS) described surgical outcomes in African adult patients. (12) Specifically, patients had a lower risk profile and fewer complications than those in high-income countries. However, postoperative mortality was twice the global average. A similar study is being performed in Latin America (LASOS), which also includes adults.

It is necessary to determine the importance of complications in pediatric surgical patients in Latin America, as well as the risk factors and types of complications that are experienced by these patients, due to the fact that data on this population are scarce. Consequently, we will be able to target appropriate interventions and funding to improve surgical outcomes for children in Latin America.