Epidemiology of anesthetic complications in pediatric surgery in Kinshasa: a multicenter historical cohort study. Original article.

Introduction Pediatric anesthesia poses unique challenges due to the physiological and anatomical characteristics of children. In low-resource settings such as the Democratic Republic of Congo, the risk of anesthetic complications remains high, significantly affecting postoperative morbidity and mortality. This study aimed to assess the incidence and risk factors of anesthetic complications in children in Kinshasa to inform strategies for improving perioperative safety. Material and Methods A retrospective cohort study included 394 children aged 0 to 15 years who underwent surgical procedures under general or regional anesthesia in four hospitals in Kin- shasa between June and December 2024. Demographic, clinical, and anesthetic data, as well as perioperative complications, were collected. Statistical analyses were performed to identify factors associated with complica- tions, with significance set at p < 0.05. Results The overall incidence of anesthetic complications was 28.4%, predominantly respiratory (14.5%) and cardiac (13.7%). Thirty-day mortality was 10.4%, with a notably higher rate among neonates (32.1% of deaths). Independ- ent risk factors included ASA score ≥ 3, emergency sur- gery, prolonged operative duration, and reoperations. Conclusion Pediatric anesthetic morbidity and mortality in Kinshasa remain substantial. Enhancing specialized training, im- proving resources, and implementing standardized proto- cols are critical to improving perioperative safety. These findings provide an evidence base to guide health policy and targeted interventions.