Outcomes of elective surgical patients admitted to a tertiary Paediatric Intensive Care Unit.
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Date
2021
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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.
Description
Masters Degree. University of KwaZulu-Natal, Durban.