1096 The African Surgical Outcomes Study in Paediatric Patients (ASOS-Paeds) and Global Paediatric Perioperative Mortality - a Meta-analysis

Abstract Aim There is little data for surgical outcomes of children in Africa. This is of particular importance as children constitute 40% of the African population, compared to a global average of 25%. As part of ASOS-Paeds - a prospective cohort study of children undergoing surgery in African countries, we undertook a meta-analysis to synthesise the evidence on global paediatric perioperative mortality. Method We searched MEDLINE, Embase and WHO Global Index Medicus for studies published within the last decade, reporting paediatric perioperative mortality. We included studies with ≥200 children that reported perioperative mortality for multiple surgical specialties and procedures. Perioperative mortality was defined as death within 30 days of surgery. For meta-analysis, proportions were combined using a random effects model. Results After screening 13,258 s and reviewing 158 full-text reports, data from 9 studies were eligible for synthesis along with data from ASOS-Paeds. The meta-analysis included 579,733 children from Africa, Europe, and North America. The pooled perioperative mortality rate per 1,000 children (95% CI) was 17.91 (9.78, 26.04) in Africa compared to 2.18 (0.95, 3.42) in Europe and North America. This equates to excess paediatric perioperative mortality in Africa between 6 (in the best-case scenario) to 25 (in the worst-case scenario) per 1,000 children. Conclusions Perioperative mortality for children undergoing surgery in Africa is 8-fold higher than in Europe and North America. Access to safe and affordable anaesthesia and surgery should be a public health priority and urgent action is needed to improve surgical outcomes for children in Africa.