H-L Kluyts1, Y le Manach2, D M Munlemvo3, F Madzimbamuto4, A Basenero5, Y Coulibaly6, S Rakotoarison7, V Gobin8, A L Samateh9, M S Chaibou10, A O Omigbodun11, S D Amanor-Boadu12, J Tumukunde13, T E Madiba14, R M Pearse15, B M Biccard16. 1. Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa. 2. Department of Anesthesia, 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; Department of 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. 3. University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo. 4. Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe. 5. Ministry of Health and Social Services Namibia, Windhoek, Namibia. 6. Department, Faculté de médicine de Bamako, Bamako, Mali. 7. Private Practice, Androhibe, Madagascar. 8. Ministry of Health and Quality of Life, Jawaharlal Nehru Hospital, Rose Belle, Grand Port, Mauritius. 9. Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia. 10. Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Niamey, Niger. 11. Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria. 12. Department of Anaesthesia, University College Hospital, Ibadan, Oyo State, Nigeria. 13. Makerere University, Makerere, Kampala, Uganda. 14. Department of Surgery, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa. 15. Intensive Care Medicine, Queen Mary University of London, London, UK. 16. Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Western Cape, South Africa. Electronic address: bruce.biccard@uct.ac.za.
Abstract
BACKGROUND: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. METHODS: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. RESULTS: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. CONCLUSIONS: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. CLINICAL TRIAL REGISTRATION: NCT03044899.
BACKGROUND: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. METHODS: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. RESULTS: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. CONCLUSIONS: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. CLINICAL TRIAL REGISTRATION: NCT03044899.
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
Authors: Antero do Vale Fernandes; Daniel Moreira-Gonçalves; Jotamo Come; Nilton Caetano Rosa; Victor Costa; Lygia Vieira Lopes; Paulo Matos da Costa; Lúcio Lara Santos Journal: Pan Afr Med J Date: 2020-06-03