# Outcomes of Thoracic Surgery in Pediatric Patients: A Single-Center Experience From Al Ribat University Hospital, Sudan

## TL;DR

This study examines the outcomes of pediatric thoracic surgeries in Sudan, highlighting high mortality rates and the need for better neonatal care and surgical support.

## Contribution

The first comprehensive review of pediatric thoracic surgery outcomes in Sudan, providing baseline data for resource-limited settings.

## Key findings

- Congenital anomalies like EA/TEF and congenital lobar emphysema were the most common surgical indications.
- Postoperative mortality was 31.8%, with EA/TEF and thoracic tumors having the highest case fatality rates.
- Neonates accounted for nearly half of the patients, with high mortality among those with complex congenital defects.

## Abstract

Background: Pediatric thoracic surgery is a diverse field with a wide variety of congenital and acquired diseases, most of which require complex perioperative care. Knowledge of local trends and outcomes is essential for optimizing surgical care in resource-constrained settings. This project aimed to present the clinical characteristics and surgical outcomes of children who underwent thoracic surgery at Al Ribat University Hospital over five years. This study represents the first comprehensive review of pediatric thoracic surgery outcomes in Sudan, providing valuable baseline data on disease patterns, perioperative complications, and survival in a resource-limited setting.

Methods: This retrospective descriptive study was conducted at the Department of Pediatric Surgery, Al Ribat University Hospital, Sudan. Medical records of all pediatric patients aged 1 day to 16 years who underwent thoracic surgery between March 2018 and March 2023 were examined. Descriptive analysis included frequencies and percentages for demographic data, surgical indications, operative details, postoperative complications, and outcomes.

Results: A total of 418 pediatric patients underwent thoracic surgery, of whom 303 (72.5%) were males. Neonates accounted for 191 patients (45.7%). Congenital lesions were the most common indication for surgery, identified in 286 patients (68.4%), including esophageal atresia/tracheoesophageal fistula (EA/TEF) in 176 patients (61.5%), congenital lobar emphysema in 51 patients (17.8%), and congenital cystic adenomatoid malformation (CCAM) in 18 patients (6.3%). Most procedures were performed through open thoracotomy (392, 93.8%), and intraoperative complications occurred in 51 patients (12.2%). Early postoperative complications developed in 133 patients (32.8%), most frequently respiratory distress in 43 patients (32.3%) and wound infection in 26 patients (19.5%). Overall postoperative mortality was 133 deaths (31.8%), with the highest case fatality rates observed in EA/TEF (89, 50.6%) and thoracic tumors (23, 41.8%).

Conclusion: Congenital anomalies, particularly EA/TEF and congenital lobar emphysema, are the dominant indications for pediatric thoracic surgery in our center. Both EA/TEF and congenital lobar emphysema and tumor conditions carry the highest mortality. Mortality among neonates with complex congenital defects remains high. The findings emphasize the need for enhanced perioperative support, improved neonatal care, and strengthened pediatric surgical services.