Risk factors for 30-day mortality following major neonatal surgery: insights from a 10-year cohort in southern Tunisia

Abstract

Purpose: This study aimed to identify the risk factors for 30-day mortality following neonatal surgery for major thoracic and abdominal conditions.

Methods: We conducted a retrospective cohort study of neonates who underwent major noncardiac abdominal or thoracic surgery in a tertiary pediatric surgery center in Tunisia between April 2015 and March 2025.

Results: A total of 361 neonates underwent major abdominal or thoracic surgeries during the study period. The male-to-female ratio was 1.3:1. The most common surgical conditions were esophageal atresia (n = 105), duodenal atresia (n = 42), and anorectal malformation (n = 39). A total of 85 neonates (23.5%) died within 30 days of surgery. According to a multivariate logistic regression analysis, five variables were independently associated with 30-day mortality.

Conclusion: This study demonstrated that an outborn status, prematurity, congenital heart disease, low 5-minute Apgar score, and prolonged operative time predict 30-day mortality after major neonatal surgery. These factors could serve as valuable tools for identifying patients at increased risk and enhancing the quality of their management.

Keywords: Congenital heart disease; Mortality; Neonatal surgery; Outborn status; Prematurity.