Taylor Wurdeman1,2, Christopher Strader3,4, Shehnaz Alidina3, David Barash5, Isabelle Citron3, Ntuli Kapologwe6, Erastus Maina7, Fabian Massaga8, Adelina Mazhiqi3,9, John G Meara3,10, Gopal Menon3, Cheri Reynolds11, Meaghan Sydlowski3, John Varallo12, Sarah Maongezi13, Mpoki Ulisubisya13. 1. Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. Taylor.wurdeman@gmail.com. 2. University of Miami Miller School of Medicine, Miami, FL, USA. Taylor.wurdeman@gmail.com. 3. Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. 4. Department of Surgery, University of Massachusetts, Worcester, MA, USA. 5. GE Foundation, Boston, MA, USA. 6. Department of Health, Social Welfare and Nutrition Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania. 7. Dalberg Advisors, New York, NY, USA. 8. Bugando Medical Centre, Consultant and Teaching University Hospital, Mwanza, Tanzania. 9. Department of Internal Medicine, Ängelholm Hospital, Ängelholm, Sweden. 10. Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA. 11. Assist International, Ripon, CA, USA. 12. Jhpiego, Baltimore, MD, USA. 13. Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania.
Abstract
BACKGROUND: Postoperative mortality rate is one of six surgical indicators identified by the Lancet Commission on Global Surgery for monitoring access to high-quality surgical care. The primary aim of this study was to measure the postoperative mortality rate in Tanzania's Lake Zone to provide a baseline for surgical strengthening efforts. The secondary aim was to measure the effect of Safe Surgery 2020, a multi-component intervention to improve surgical quality, on postoperative mortality after 10 months. METHODS: We prospectively collected data on postoperative mortality from 20 health centers, district hospitals, and regional hospitals in Tanzania's Lake Zone over two time periods: pre-intervention (February to April 2018) and post-intervention (March to May 2019). We analyzed postoperative mortality rates by procedure type. We used logistic regression to determine the impact of Safe Surgery 2020 on postoperative mortality. RESULTS: The overall average in-hospital non-obstetric postoperative mortality rate for all surgery procedures was 2.62%. The postoperative mortality rates for laparotomy were 3.92% and for cesarean delivery was 0.24%. Logistic regression demonstrated no difference in the postoperative mortality rate after the Safe Surgery 2020 intervention. CONCLUSIONS: Our results inform national surgical planning in Tanzania by providing a sub-national baseline estimate of postoperative mortality rates for multiple surgical procedures and serve as a basis from which to measure the impact of future surgical quality interventions. Our study showed no improvement in postoperative mortality after implementation of Safe Surgery 2020, possibly due to low power to detect change.
BACKGROUND: Postoperative mortality rate is one of six surgical indicators identified by the Lancet Commission on Global Surgery for monitoring access to high-quality surgical care. The primary aim of this study was to measure the postoperative mortality rate in Tanzania's Lake Zone to provide a baseline for surgical strengthening efforts. The secondary aim was to measure the effect of Safe Surgery 2020, a multi-component intervention to improve surgical quality, on postoperative mortality after 10 months. METHODS: We prospectively collected data on postoperative mortality from 20 health centers, district hospitals, and regional hospitals in Tanzania's Lake Zone over two time periods: pre-intervention (February to April 2018) and post-intervention (March to May 2019). We analyzed postoperative mortality rates by procedure type. We used logistic regression to determine the impact of Safe Surgery 2020 on postoperative mortality. RESULTS: The overall average in-hospital non-obstetric postoperative mortality rate for all surgery procedures was 2.62%. The postoperative mortality rates for laparotomy were 3.92% and for cesarean delivery was 0.24%. Logistic regression demonstrated no difference in the postoperative mortality rate after the Safe Surgery 2020 intervention. CONCLUSIONS: Our results inform national surgical planning in Tanzania by providing a sub-national baseline estimate of postoperative mortality rates for multiple surgical procedures and serve as a basis from which to measure the impact of future surgical quality interventions. Our study showed no improvement in postoperative mortality after implementation of Safe Surgery 2020, possibly due to low power to detect change.
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Authors: Joshua S Ng-Kamstra; Sumedha Arya; Sarah L M Greenberg; Meera Kotagal; Catherine Arsenault; David Ljungman; Rachel R Yorlets; Arnav Agarwal; Claudia Frankfurter; Anton Nikouline; Francis Yi Xing Lai; Charlotta L Palmqvist; Terence Fu; Tahrin Mahmood; Sneha Raju; Sristi Sharma; Isobel H Marks; Alexis Bowder; Lebei Pi; John G Meara; Mark G Shrime Journal: BMJ Glob Health Date: 2018-06-22