Assessment of Paediatric Surgical Referral Patterns and Outcomes at University of Port Harcourt Teaching Hospital, South South Nigeria

Timely surgical referral of paediatric patients with conditions requiring operative intervention is essential for reducing morbidity and mortality. However, referral delays and inadequate pre-referral management remain significant challenges across Nigeria. This retrospective study assesses the referral patterns, pre-referral management quality, and surgical outcomes of paediatric patients referred to the surgical unit of the University of Port Harcourt Teaching Hospital (UPTH), Rivers State, South South Nigeria, over a three-year period from 2021 to 2023. Medical records and referral letters of 362 children aged zero to 15 years were reviewed. Variables included referring facility level, primary diagnosis, time from symptom onset to referral, pre-referral interventions, and post-operative outcomes. Appendicitis (19.6%), intussusception (16.0%), and inguinal hernia (14.1%) were the most common conditions requiring referral. Primary healthcare centres accounted for only 12.2% of referrals, with most (61.0%) originating from secondary facilities. Delayed referral beyond 48 hours of symptom onset occurred in 58.3% of cases. Appropriate pre-referral stabilisation was documented in only 47.5% of referred children. Post-operative complication rate was 22.6%, significantly higher among cases with delayed referral. The study recommends developing standardised surgical referral protocols, training primary care teams on recognition and stabilisation of acute surgical conditions in children, and strengthening referral communication systems. Keywords: paediatric surgery, referral patterns, surgical outcomes, Port Harcourt, South South Nigeria.