Paediatric Surgery at a Regional Hospital

Abstract

Infants and young children are at particular risk from anaesthesia and surgery. Some
have suggested that these patients only be cared for by those with specialty paediatric
surgical and anaesthetic training. In district hospitals and the developing world this
is often not possible. We have undertaken a prospective study to determine the mortality
and morbidity rate for children 0 to 5 years undergoing surgery at Western Regional
Hospital (WRH) in Pokhara, Nepal. During 1999 there were 354 patients in this age
group undergoing surgery. Surgical procedures were done in general surgery (covering
urology, plastics and neurosurgery as well), orthopaedics, ENT and ophthalmology.
There were 6 deaths for a mortality rate of 1.7%. Seven patients had in hospital
complications and significant management problems were identified in four patients.
In conclusion, although there is no dedicated paediatric surgical unit at WRH, children
undergoing surgery at this hospital have acceptable morbidity and mortality rates.
An improvement in timely presentation, diagnosis, treatment and intraoperative
monitoring may further improve these results.