Bruce M Biccard1, Thandinkosi E Madiba2, Hyla-Louise Kluyts3, Dolly M Munlemvo4, Farai D Madzimbamuto5, Apollo Basenero6, Christina S Gordon6, Coulibaly Youssouf7, Sylvia R Rakotoarison8, Veekash Gobin9, Ahmadou L Samateh10, Chaibou M Sani11, Akinyinka O Omigbodun12, Simbo D Amanor-Boadu13, Janat T Tumukunde14, Tonya M Esterhuizen15, Yannick Le Manach16, Patrice Forget17, Abdulaziz M Elkhogia18, Ryad M Mehyaoui19, Eugene Zoumeno20, Gabriel Ndayisaba21, Henry Ndasi22, Andrew K N Ndonga23, Zipporah W W Ngumi24, Ushmah P Patel25, Daniel Zemenfes Ashebir26, Akwasi A K Antwi-Kusi27, Bernard Mbwele28, Hamza Doles Sama29, Mahmoud Elfiky30, Maher A Fawzy31, Rupert M Pearse32. 1. Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa. Electronic address: bruce.biccard@uct.ac.za. 2. Department of Surgery, University of KwaZulu-Natal, South Africa. 3. Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa. 4. Anaesthesiology, University Hospital of Kinshasha, Democratic Republic of the Congo. 5. Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Avondale, Harare, Zimbabwe. 6. Ministry of Health and Social Services Namibia, Windhoek, Namibia. 7. Faculté de Médicine de Bamako, Bamako, Mali. 8. LOT II M 46 R, Androhibe, Tana, Madagascar. 9. Ministry of Health and Quality of Life, Jawaharlal Nehru Hospital, Rose Belle, Mauritius. 10. Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, The Gambia. 11. Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Niamey, Republic of Niger. 12. Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria. 13. Department of Anaesthesia, University College Hospital, Ibadan, Nigeria. 14. Anaesthesiology, Makerere University, Kampala, Uganda. 15. Centre for Evidence Based Health Care, Stellenbosch University, Stellenbosch, South Africa. 16. Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, ON, Canada. 17. Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Anesthesiology and Perioperative Medicine, Brussels, Belgium. 18. Anaesthesia Department, Tripoli Medical Centre, Tripoli, Libya. 19. Hospital of Cardiovasculaire Pathology, Universitar Hospital, Algeria. 20. Faculté des Sciences de la Santé de Cotonou, Hôpital de la mère et de l'enfant, Lagune de Cotonou, Benin. 21. Kamenge Teaching Hospital, Department of Surgery, Bujumbura, Burundi. 22. Department of Orthopaedics and General Surgery, Baptist Hospital, Mutengene, Cameroon. 23. General and Gastrosurgery, Mater Hospital, Kenya. 24. Department of Anaesthesia, University of Nairobi School of Medicine, Nairobi, Kenya. 25. Anaesthesiology, University Teaching Hospital, Lusaka, Zambia. 26. Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia. 27. Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. 28. HIV/AIDS Care and Treatment & PMTCT, Christian Social Service Commission, Mwanza, Tanzania. 29. Anaesthesia Intensive Care Medicine Pain Management, Sylvanus Olympio University Teaching Hospital, Lomé TOGO, Togo. 30. Department of Surgery, Cairo University, Cairo, Egypt. 31. Anesthesia, ICU & Pain Management Departments, Faculty of Medicine, Cairo University, Cairo, Egypt. 32. Intensive Care Medicine, Queen Mary University of London, London, UK.
Abstract
BACKGROUND: There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. METHODS: We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899). FINDINGS: We recruited 11 422 patients (median 29 [IQR 10-70]) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000-2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2-1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65-578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years [SD 16·1]), with a lower risk profile (American Society of Anesthesiologists median score 1 [IQR 1-2]) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18·2%, 95% CI 17·4-18·9]) of 10 885 patients. 239 (2·1%) of 11 193 patients died, 225 (94·1%) after the day of surgery. Infection was the most common complication (1156 [10·2%] of 10 970 patients), of whom 112 (9·7%) died. INTERPRETATION: Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective. FUNDING: Medical Research Council of South Africa.
BACKGROUND: There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. METHODS: We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899). FINDINGS: We recruited 11 422 patients (median 29 [IQR 10-70]) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000-2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2-1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65-578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years [SD 16·1]), with a lower risk profile (American Society of Anesthesiologists median score 1 [IQR 1-2]) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18·2%, 95% CI 17·4-18·9]) of 10 885 patients. 239 (2·1%) of 11 193 patients died, 225 (94·1%) after the day of surgery. Infection was the most common complication (1156 [10·2%] of 10 970 patients), of whom 112 (9·7%) died. INTERPRETATION: Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective. FUNDING: Medical Research Council of South Africa.
Authors: Margaret E Kruk; Anna D Gage; Catherine Arsenault; Keely Jordan; Hannah H Leslie; Sanam Roder-DeWan; Olusoji Adeyi; Pierre Barker; Bernadette Daelmans; Svetlana V Doubova; Mike English; Ezequiel García-Elorrio; Frederico Guanais; Oye Gureje; Lisa R Hirschhorn; Lixin Jiang; Edward Kelley; Ephrem Tekle Lemango; Jerker Liljestrand; Address Malata; Tanya Marchant; Malebona Precious Matsoso; John G Meara; Manoj Mohanan; Youssoupha Ndiaye; Ole F Norheim; K Srinath Reddy; Alexander K Rowe; Joshua A Salomon; Gagan Thapa; Nana A Y Twum-Danso; Muhammad Pate Journal: Lancet Glob Health Date: 2018-09-05 Impact factor: 26.763
Authors: Isobel H Marks; Zhi Ven Fong; Sahael M Stapleton; Ya-Ching Hung; Yanik J Bababekov; David C Chang Journal: World J Surg Date: 2018-08 Impact factor: 3.352
Authors: Thomas F Burke; Sebastian Suarez; Ayla Senay; Charles Masaki; Khama Rogo; Daniel I Sessler; Taha Yusufali; Debora Rogo; Moytrayee Guha; Pankaj Jani; Brett D Nelson Journal: World J Surg Date: 2018-09 Impact factor: 3.352
Authors: Jessica Spence; Yannick LeManach; Matthew TV Chan; C Y Wang; Alben Sigamani; Denis Xavier; Rupert Pearse; Pablo Alonso-Coello; Ignacio Garutti; Sadeesh K Srinathan; Emmanuelle Duceppe; Michael Walsh; Flavia Kessler Borges; German Malaga; Valsa Abraham; Atiya Faruqui; Otavio Berwanger; Bruce M Biccard; Juan Carlos Villar; Daniel I Sessler; Andrea Kurz; Clara K Chow; Carisi A Polanczyk; Wojciech Szczeklik; Gareth Ackland; Garg Amit X; Michael Jacka; Gordon H Guyatt; Robert J Sapsford; Colin Williams; Olga Lucia Cortes; Pierre Coriat; Ameen Patel; Maria Tiboni; Emilie P Belley-Côté; Stephen Yang; Diane Heels-Ansdell; Michael McGillion; Simon Parlow; Matthew Patel; Shirley Pettit; Salim Yusuf; P J Devereaux Journal: CMAJ Date: 2019-07-29 Impact factor: 8.262
Authors: Hyla-Louise Kluyts; Wilhelmina Conradie; Estie Cloete; Sandra Spijkerman; Oliver Smith; Ahmed Alli; Modise Z Koto; Odisang D Montwedi; Komalan Govender; Larissa Cronjé; Mariette Grobbelaar; Jones A Omoshoro-Jones; Nicolette F Rorke; Philip Anderson; Alexandra Torborg; Christella Alphonsus; Panagiotis Alexandris; Aunel Mallier Peter; Usha Singh; Johan Diedericks; Busisiwe Mrara; Anthony Reed; Gareth L Davies; Jody G Davids; Hendrik A Van Zyl; Vishendran Govindasamy; Reitze Rodseth; Roel Matos-Puig; Kajake A P Bhat; Noel Naidoo; John Roos; Magdalena Jaworska; Annemarie Steyn; Johannes M Dippenaar; R M Pearse; Thandinkosi Madiba; Bruce M Biccard Journal: World J Surg Date: 2020-10-30 Impact factor: 3.352