Outcomes of elective surgical patients admitted to a tertiary Paediatric Intensive Care Unit.

Abstract

Background: A paediatric intensive care unit (PICU) is a unit for critically ill medical and surgical children. It is imperative that the spectrum and outcome of elective surgical patients is reviewed to help develop admission criteria for elective surgical patients to assist in prudent resource allocation. Objectives: To describe the clinical characteristics, diagnosis, complications, and outcome of elective surgical admissions, to the PICU. Methods: A retrospective chart review of all elective paediatric surgical patients admitted between 01 January 2018 to 31 December 2019 at Grey’s Hospital PICU, a tertiary hospital. All elective surgical patients admitted at Grey’s PICU were included in the study. Data was analyzed using the statistical analysis involved both descriptive and inferential statistics. The descriptive statistics included frequency tables for categorical variables and number summaries for continuous variables. To determine the factors associated length of stay, general linear model was fitted using the Gamma family distribution since the length of stay was skewed. All the tests were benchmarked at α = 0.05 level of significance. Ethical approval to access patient records was obtained from the Biomedical Research Ethics Committee of University of KZN (BREC/00001304/2020), Greys Hospital and Department of health. Results: There were 320 elective surgical bed requests for PICU of which 279 (87.2%) were accepted but only 234 were admitted to PICU, the rest did not require PICU post theatre. Forty one (12.8%) were not accepted due to unavailability of resources. The median age for this study population was 2 years (0 - 16 years). Gender distribution 50.0% were male, 35.0% female and 15.0% unknown. The majority, 80.9% were HIV negative with normal nutritional status (75.9%). Elective surgical admissions constituted 30.0% (234/ 798) of total PICU all admissions. The average waiting period was 4.0 days with an average length of stay of 2 days. With regards to indications for surgery, the majority were for airway problems 91 (28.0%) and 45 (14.2%) for feeding difficulties. 158 (49.7%) had no reported comorbidity. The most common comorbidity was cerebral palsy 5 (11.0%) followed by right heart failure 19 (6.0%). With regards to outcomes, 98.7% were discharged with no complications and 3 (1.3 %) died.

Conclusion: Elective surgical admissions constituted a third of all PICU admissions with the majority having upper airways abnormalities, with a good outcome. Majority of bed requests were met. Mortality was low and length of stay was shorter amongst the elective surgical cases. Children under the age or one year requiring surgery need prioritization for access to post operative PICU care.