Introduction As childhood mortality from infectious diseases falls across sub-Saharan Africa (SSA), the burden of disease attributed to surgical conditions is increasing. However, limited data exist on paediatric surgical outcomes in SSA. We compared the outcomes of five common paediatric surgical conditions in SSA with published benchmark data from high-income countries (HICs). Methods A multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery. The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A p<0.05 was deemed significant. Results 1407 children from 51 hospitals in 19 countries across SSA were studied: 111 with gastroschisis, 188 anorectal malformation, 225 intussusception, 250 appendicitis and 633 inguinal hernia. Mortality was significantly higher in SSA compared with HICs for all conditions: gastroschisis (75.5% vs 2.0%), anorectal malformation (11.2% vs 2.9%), intussusception (9.4% vs 0.2%), appendicitis (0.4% vs 0.0%) and inguinal hernia (0.2% vs 0.0%), respectively. Mortality was 41.9% (112/267) among neonates, 5.0% (20/403) in infants and 1.0% (7/720) in children. Paediatric surgical condition, higher American Society of Anesthesiologists score at primary intervention, and needing/receiving a blood transfusion were significantly associated with mortality on multivariable analysis. Conclusion Mortality from common paediatric surgical conditions is unacceptably high in SSA compared with HICs, particularly for neonates. Interventions to reduce mortality should focus on improving resuscitation and timely transfer at the district level, and preoperative resuscitation and perioperative care at paediatric surgical centres. Once published, the full anonymous, de-identified patient and hospital datasets will be made publicly available via the Centre for Open Science website: .

中文翻译：

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撒哈拉以南非洲小儿外科手术结果：一项多中心、国际、前瞻性队列研究

引言 由于传染病导致的儿童死亡率在整个撒哈拉以南非洲地区 (SSA) 有所下降，因此由外科手术引起的疾病负担正在增加。然而，关于 SSA 中儿科手术结果的数据有限。我们将 SSA 中五种常见儿科手术状况的结果与来自高收入国家 (HIC) 的已发布基准数据进行了比较。方法 在跨 SSA 提供儿科外科护理的医院进行了一项多中心、国际、前瞻性队列研究。收集了 2016 年 10 月至 2017 年 4 月期间至少 1 个月内出现腹裂、肛门直肠畸形、肠套叠、阑尾炎或腹股沟疝的连续儿童（出生至 16 岁）的数据。参与医院完成了对其可用资源的调查用于小儿外科手术。主要结局是全因住院死亡率。使用 χ2 分析将 SSA 中的死亡率与 HIC 中公布的基准死亡率进行比较。广义线性混合模型用于确定影响死亡率的患者水平和医院水平因素。p<0.05被认为是显着的。结果 研究了来自 SSA 19 个国家 51 家医院的 1407 名儿童：111 名腹裂、188 名肛门直肠畸形、225 名肠套叠、250 名阑尾炎和 633 名腹股沟疝。在所有情况下，SSA 的死亡率显着高于 HIC：胃裂（75.5% 对 2.0%）、肛门直肠畸形（11.2% 对 2.9%）、肠套叠（9.4% 对 0.2%）、阑尾炎（0.4% 对 0.0%）和腹股沟疝（0.2% vs 0.0%）。新生儿死亡率为 41.9% (112/267)，婴儿死亡率为 5.0% (20/403)，儿童死亡率为 1.0% (7/720)。在多变量分析中，儿科手术状况、美国麻醉医师协会在初级干预中的较高评分以及需要/接受输血与死亡率显着相关。结论 与 HIC 相比，SSA 中常见儿科手术疾病的死亡率高得令人无法接受，尤其是新生儿。降低死亡率的干预措施应侧重于改善地区层面的复苏和及时转移，以及儿科手术中心的术前复苏和围手术期护理。一旦发布，完整的匿名、去标识化患者和医院数据集将通过开放科学中心网站公开提供：在多变量分析中，需要/接受输血与死亡率显着相关。结论 与 HIC 相比，SSA 中常见儿科手术疾病的死亡率高得令人无法接受，尤其是新生儿。降低死亡率的干预措施应侧重于改善地区层面的复苏和及时转移，以及儿科手术中心的术前复苏和围手术期护理。一旦发布，完整的匿名、去标识化患者和医院数据集将通过开放科学中心网站公开提供：在多变量分析中，需要/接受输血与死亡率显着相关。结论 与 HIC 相比，SSA 中常见儿科手术疾病的死亡率高得令人无法接受，尤其是新生儿。降低死亡率的干预措施应侧重于改善地区层面的复苏和及时转移，以及儿科手术中心的术前复苏和围手术期护理。一旦发布，完整的匿名、去标识化患者和医院数据集将通过开放科学中心网站公开提供：降低死亡率的干预措施应侧重于改善地区层面的复苏和及时转移，以及儿科手术中心的术前复苏和围手术期护理。一旦发布，完整的匿名、去标识化患者和医院数据集将通过开放科学中心网站公开提供：降低死亡率的干预措施应侧重于改善地区层面的复苏和及时转移，以及儿科手术中心的术前复苏和围手术期护理。一旦发布，完整的匿名、去标识化患者和医院数据集将通过开放科学中心网站公开提供：.