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

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. 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. 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. 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). 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. • A review on the neonatal 24-h and 30-day perioperative mortality rates (POMRs) • Mortality was assessed according to countries' Human Development Indexes (HDIs) • The review showed high global 24-h POMR and very high global 30-day POMR • The 24-h and 30-day POMRs are substantially high in low-HDI countries • Neonates represent a challenge in perioperative care in all countries in this century [ABSTRACT FROM AUTHOR]