Global neonatal perioperative mortality: A systematic review and meta-analysis

Leandro G Braz; Jose Reinaldo C Braz; Teofilo Augusto A Tiradentes; Joao Vitor A Soares; Jose E Corrente; Norma Sueli P Modolo; Paulo do Nascimento Junior; Mariana G Braz

doi:10.1016/j.jclinane.2024.111407

Global neonatal perioperative mortality: A systematic review and meta-analysis

J Clin Anesth. 2024 Jun:94:111407. doi: 10.1016/j.jclinane.2024.111407. Epub 2024 Feb 6.

Authors

Leandro G Braz¹, Jose Reinaldo C Braz², Teofilo Augusto A Tiradentes², Joao Vitor A Soares², Jose E Corrente³, Norma Sueli P Modolo², Paulo do Nascimento Junior², Mariana G Braz²

Affiliations

¹ Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil. Electronic address: leandro.braz@unesp.br.
² Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.
³ Department of Biostatistics, Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.

PMID: 38325248
DOI: 10.1016/j.jclinane.2024.111407

Abstract

Study objective: There are large differences in health care among countries. A higher perioperative mortality rate (POMR) in neonates than in older children and adults has been recognized worldwide. The aim of this study was to provide a systematic review of published 24-h and 30-day POMRs in neonates from 2011 to 2022 in countries with different Human Development Index (HDI) levels.

Design and setting: A systematic review with a meta-analysis of studies that reported 24-h and 30-day POMRs in neonates was performed. We searched the databases from January 2011 to July 30, 2022.

Measurements: The POMRs (per 10,000 procedures under anesthesia) were analyzed according to country HDI. The HDI levels ranged from 0 to 1, representing the lowest and highest levels, respectively (very-high-HDI: ≥ 0.800, high-HDI: 0.700-0.799, medium-HDI: 0.550-0.699, and low-HDI: < 0.550). The magnitude of the POMRs by country HDI was studied using meta-analysis.

Main results: Eighteen studies from 45 countries were included. The 24-h (n = 96 deaths) and 30-day (n = 459 deaths) POMRs were analyzed from 33,729 anesthetic procedures. The odds ratios (ORs) of the 24-h POMR in low-HDI countries were higher than those in very-high- (OR 8.4, 95% CI 1.7-40.4; p = 0.008), high- (OR 7.3, 95% CI 2.2-24.4; p = 0.001) and medium-HDI countries (OR 7.7, 95% CI 3.1-18.7; p < 0.0001) but with no odds differences between very-high- and high-HDI countries (p = 0.879), very-high- and medium-HDI countries (p = 0.915) and high- and medium-HDI countries (p = 0.689). The odds of a 30-day POMR in low-HDI countries were higher than those in very-high-HDI countries (OR 6.9, 95% CI 1.9-24.6; p = 0.002) but not in high-HDI countries (OR 1.4, 95% CI 0.6-3.0; p = 0.396).

Conclusions: The review demonstrated very high global POMRs in a surgical population of neonates independent of the country HDI level. We identified differences in 24-h and 30-day POMRs between low-HDI countries and other countries with higher HDI levels.

Keywords: Anesthesia; High-income population; Low-income population; Mortality; Newborn; Surgery.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Child
Delivery of Health Care*
Humans
Infant, Newborn