Risk Factors for Postoperative Complications Following Paediatric Abdominal Surgery at a Tertiary Care Hospital

Abstract

Objective: To identify patient- and procedure-related risk factors associated with postoperative complications among children undergoing abdominal surgery at a tertiary care hospital.

Methods: This retrospective cohort study was conducted at the Department of Paediatric Surgery, Khyber Teaching Hospital (MTI-KTH), Peshawar, Pakistan, from July 2025 to December 2025. Medical records of 200 pediatric patients (<18 years) who underwent elective or emergency abdominal surgery were reviewed. Data collected included age, sex, nutritional status, emergency surgery, type of surgery, American Society of Anesthesiologists (ASA) physical status, operative duration, estimated blood loss, wound classification, preoperative anemia, and comorbidities. Postoperative outcomes included surgical site infection (SSI), anastomotic leak, postoperative ileus, pneumonia, sepsis, reoperation, and in-hospital mortality. Data were analyzed using descriptive statistics, univariate analysis, and multivariable logistic regression. Statistical significance was set at p < 0.05.

Results: The study included 200 children with a mean age of 8.25 ± 5.66 years, equally distributed between males and females. Overall, 110 (55.0%) patients experienced at least one postoperative complication. Surgical site infection was the most common complication (30.5%), followed by postoperative ileus (23.0%), pneumonia (20.0%), sepsis (20.0%), reoperation (20.0%), anastomotic leak (15.5%), and mortality (5.0%). Emergency surgery, higher ASA grade, prolonged operative duration, greater intraoperative blood loss, contaminated or dirty wounds, preoperative anemia, comorbidities, and undernutrition were identified as independent predictors of postoperative complications.

Conclusion: Postoperative complications remain frequent following pediatric abdominal surgery and are significantly associated with both patient- and procedure-related factors. Early risk stratification, optimization of modifiable risk factors, and adherence to evidence-based perioperative care may reduce postoperative morbidity and improve surgical outcomes in children.