The incidence of perioperative critical events in paediatric patients at a Johannesburg Academic Hospital

Abstract

Background Critical events in anaesthesia have been defined as events that require immediate intervention to prevent major disability or death. South African paediatric research on risk factors and critical events is limited. The aim of this study was to describe the perioperative critical events in paediatric patients at Rahima Moosa Mother and Child Hospital in Johannesburg. The objectives were to determine the incidence and management of perioperative critical events, risk factors, and to describe immediate postoperative outcomes. Methods A prospective observational cross-sectional study was conducted. It included 206 patients up to the age of 12 undergoing anaesthesia for elective and emergency procedures. Results The median age of patients with critical events was four years with a weight of 13kg. The cumulative incidence of critical events was 34% (95% CI, 27-40) with hypoglycaemia having the highest incidence of 21% (95% CI,16-27). The incidence of respiratory critical events was 11% (95% CI, 7-16), emergence delirium 2.4% (95% CI, 0.90-5.9%), cardiovascular events 1.9% (95% CI,0.62-5.2%) and temperature abnormalities was 0.5% (95% CI, 0.03- 3.1). Risk factors associated with respiratory events included younger age [OR (95% CI) = 0.63 (0.40, 1.00), p = 0.049] and the use of endotracheal tubes [endotracheal tube vs facemask: OR = 0.07 (0.00, 0.42), p = 0.016; endotracheal tube vs supraglottic: OR = 0.18 (0.03, 0.77), p = 0.041]. Management of the events varied according to physician preferences. Of the patients included, 87% were discharged to the ward. Conclusion The cumulative incidence of critical events was almost seven times higher than that reported in high income countries, and more than double than in a large South African multi-centre study. Hypoglycaemia was the biggest contributor emphasising the importance of correct implementation of preoperative fasting guidelines. Attention should be given to improve in- service training and continuous medical education to improve patient outcomes.