Background: Child health is a key priority on the
global health agenda, yet the provision of essential and
emergency surgery in children is patchy in resourcepoor
regions. This study was aimed to determine the
mortality risk for emergency abdominal paediatric
surgery in low-income countries globally.
Methods: Multicentre, international, prospective,
cohort study. Self-selected surgical units performing
emergency abdominal surgery submitted prespecified
data for consecutive children aged <16 years during a
2-week period between July and December 2014. The
United Nation’s Human Development Index (HDI) was
used to stratify countries. The main outcome measure
was 30-day postoperative mortality, analysed by
multilevel logistic regression.
Results: This study included 1409 patients from
253 centres in 43 countries; 282 children were under
2 years of age. Among them, 265 (18.8%) were from
low-HDI, 450 (31.9%) from middle-HDI and 694
(49.3%) from high-HDI countries. The most common
operations performed were appendectomy, small bowel
resection, pyloromyotomy and correction of
intussusception. After adjustment for patient and
hospital risk factors, child mortality at 30 days was
significantly higher in low-HDI (adjusted OR 7.14
(95% CI 2.52 to 20.23), p<0.001) and middle-HDI
(4.42 (1.44 to 13.56), p=0.009) countries compared
with high-HDI countries, translating to 40 excess
deaths per 1000 procedures performed.
Conclusions: Adjusted mortality in children following
emergency abdominal surgery may be as high as
7 times greater in low-HDI and middle-HDI countries
compared with high-HDI countries. Effective provision
of emergency essential surgery should be a key priority
for global child health agendas.