1. Perioperative patient outcomes in the African Surgical Outcomes Study
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Bruce M Biccard, Thandinkosi E Madiba, Hyla-Louise Kluyts, Dolly M Munlemvo, Farai D Madzimbamuto, Apollo Basenero, Christina S Gordon, Coulibaly Youssouf, Sylvia R Rakotoarison, Veekash Gobin, Ahmadou L Samateh, Chaibou M Sani, Akinyinka O Omigbodun, Simbo D Amanor-Boadu, Janat T Tumukunde, Tonya M Esterhuizen, Yannick Le Manach, Patrice Forget, Abdulaziz M Elkhogia, Ryad M Mehyaoui, Eugene Zoumeno, Gabriel Ndayisaba, Henry Ndasi, Andrew K N Ndonga, Zipporah W W Ngumi, Ushmah P Patel, Daniel Zemenfes Ashebir, Akwasi A K Antwi-Kusi, Bernard Mbwele, Hamza Doles Sama, Mahmoud Elfiky, Maher A Fawzy, Rupert M Pearse, Hippolyte Abadagan, N Abbas, A Ibrahim Abdelatif, Traoré Abdoulaye, A Abd-rouf, A Abduljalil, A Abdulrahman, S Abdurazig, A Abokris, W Abozaid, SOA Abugassa, F Abuhdema, SA Abujanah, R Abusamra, A Abushnaf, SA Abusnina, TS Abuzalout, HM Ackermann, YB Adamu, A Addanfour, DM Adeleke, TA Adigun, AO Adisa, Sèhivè Valéry Adjignon, NA Adu-Aryee, BB Afolabi, AFX Agaba, PKA Agaba, K Aghadi, H Agilla, B Ahmed, El-Z Ahmed, Al-J Ahmed, M Ahmed, Rene Ahossi, SA Aji, S Akanyun, I Akhideno, M Akhter, OA Akinyemi, M Akkari, Joseph Akodjenou, AL AL Samateh, ES al Shams, OT Alagbe-Briggs, EA Alakkari, RB Alalem, M Alashhab, OI Alatise, A Alatresh, MSI Alayeb Alayeb, BA Albakosh, F Albert, ANJD Alberts, AD Aldarrat, A Alfari, A Alfetore, M Algbali, A Algddar, HA Algedar, IA Alghafoud, A Alghazali, M Alhajj, A Alhendery Alhendery, FFH Alhoty, A Ali, YA Ali, Beye Seïdina Alioune, MA Alkassem, MA Alkchr, TS Alkesa, A Alkilani, F Alkobty Alkobty, Thomas Allaye, SBM Alleesaib, A Alli, K Allopi, NL Allorto, A Almajbery, R Almesmary, SHA Almisslati, F Almoraid, H Alobeidi, MA Alomami, Christella S Alphonsus, OA Alqawi, AA Alraheem, SA Alsabri, A Alsayed, B Alsellabi, M Al-Serksi, MSA Alshareef, AA Altagazi, JS Aluvale, HW Alwahedi, EA Alzahra, MA Alzarouk, K Al-Zubaidy, M Amadou, Maiga Amadou, Al-A Amer, BT Amisi, MA Amuthenu, TWA Anabah, Felix Anani, PGR Anderson, AGB Andriamampionona, L Andrianina, A Anele, R Angelin, N Anjar, O Antùnez, Akwasi Antwi-Kusi, LJC Anyanwu, AA Aribi, OA Arowolo, O Arrey, SB Assefa, Guy Assoum, V Athanse, JS Athombo, M Atiku, E Atito-Narh, Anatole Atomabe, A Attia, M Aungraheeta, DMA Aurélia, OO Ayandipo, AET Ayebale, HMZ Azzaidey, NB Babajee, HB Badi, EK Badianga, RB Baghni, MT Bahta, M Bai, Y Baitchu, AM Baloyi, KA Bamuza, MI Bamuza, L Bangure, OB Bankole, ML Barongo, MM Barow, L Bashiya, CH Basson, Sudha Bechan, S Belhaj, MM Ben Mansour, D Benali, ASB Benamour, A Berhe, JD Bertie, JJA Bester, M Bester, JD Bezuidenhout, K Bhagwan, DR Bhagwandass, KAP Bhat, MMZU Bhuiyan, F Bigirimana, CJ Bikuelo, BE Bilby, SS Bingidimi, KE Bischof, David G Bishop, C Bitta, M Bittaye, Thuli Biyase, CA Blake, E Blignaut, F Blignaut, BN BN Tanjong, A Bogoslovskiy, PM Boloko, SKB Boodhun, I Bori, F Boufas, M Brand, Nicholas T Brouckaert, JD Bruwer, I Buccimazza, IM Bula Bula, Fred Bulamba, BC Businge, YB Bwambale, SRC Cacala, MA Cadersa, Chris Cairns, F Carlos, ME Casey, AC Castro, ND Chabayanzara, MS Chaibou, TNO Chaibva, NK Chakafa, C Chalo, C Changfoot, MC Chari, L Chelbi, JT Chibanda, HN Chifamba, N Chikh, E Chikumba, P Chimberengwa, J Chirengwa, FM Chitungo, MC Chiwanga, MM Chokoe, TM Chokwe, B Chrirangi, M Christian, B Church, JC Cisekedi, JN Clegg-Lamptey, Estie Cloete, Megan Coltman, W Conradie, N Constance, Youssouf Coulibaly, L Cronje, MA Da Silva, H Daddy, L Dahim, D Daliri, MS Dambaki, A Dasrath, JG Davids, Gareth L Davies, JT De Lange, JB de Wet, B Dedekind, MA Degaulle, V Dehal, PD Deka, S Delinikaytis, IS Desalu, Hubert Dewanou, MB Moussa Deye, C Dhege, BSG Diale, DF Dibwe, BJS Diedericks, JM Dippenaar, L Dippenaar, MP Diyoyo, Edith Djessouho, SN Dlamini, A Dodiyi-Manuel, BA Dokolwana, DP Domoyyeri, Leanne W Drummond, DE du Plessis, WM du Plessis, LJ du Preez, K Dube, NZ Dube, KD Dullab, R Duvenhage, RC Echem, SA Edaigbini, AK Egote, A Ehouni, G Ekwen, NC Ekwunife, M El Hensheri, IE Elfaghi, MA Elfagieh, S Elfallah, S Elgelany, AM Elghallal, MG Elghandouri, ZS Elghazal, AM Elghobashy, FT Elharati, RM Elkhwildi, S Ellis, L Elmadani, HB Elmadany, H Elmehdawi, A Elmgadmi, H Eloi, D Elrafifi, G Elsaadi, RB Elsaity, A Elshikhy, M Eltaguri, A Elwerfelli, IE Elyasir, AZ Elzoway, AM Elzufri, EO Enendu, BC Enicker, EO Enwerem, R Esayas, M Eshtiwi, AA Eshwehdi, JL Esterhuizen, EB Etuk, O Eurayet, OR Eyelade, RF Fanjandrainy, Lionelle Fanou, Z Farina, Maher Fawzy, A Feituri, NL Fernandes, LM Ford, T François, T Freeman, YBM Freeman, VM Gacii, B Gadi, M Gagara, A Gakenia, PD Gallou, GGN Gama, MG Gamal, YG Gandy, A Ganesh, Diallo Gangaly, M Garcia, AP Gatheru, SSD Gaya, Oswald Gbéhadé, G Gerbel, A Ghnain, R Gigabhoy, DG Giles, GT Girmaye, S Gitau, B Githae, Said Gitta, Riaz Goga, AAG Gomati, ME Gonzalez, J Gopall, Christina Salmina Gordon, O Gorelyk, M Gova, K Govender, P Govender, S Govender, V Govindasamy, JTK Green-Harris, MB Greenwood, SV Grey-Johnson, Mariette Grobbelaar, MA Groenewald, KK Grünewald, Ambroise Guegni, M Guenane, S Gueye, Marius Guezo, T Gunguwo, MG Gweder, M Gwila, L Habimana, Rodrigue Hadecon, E Hadia, L Hamadi, M Hammouda, MI Hampton, R Hanta, Tim C Hardcastle, JA Hariniaina, S Hariparsad, AH Harissou, R Harrichandparsad, SHA Hasan, HB Hashmi, MP Hayes, A Hdud, SH Hebli, HMSN Heerah, S Hersi, AH Hery, Adam Hewitt-Smith, TC Hlako, SCH Hodges, Richard Eric Hodgson, M Hokoma, H Holder, EB Holford, E Horugavye, C Houston, M Hove, D Hugo, CM Human, H Hurri, O Huwidi, AI Ibrahim, Traoré Ibrahim, OK Idowu, IE Igaga, John Igenge, O Ihezie, K Ikandi, IAR Ike, JJN Ikuku, MN Ilbarasi, IBB Ilunga, JPM Ilunga, NAV Imbangu, Z Imessaoudene, DH Imposo, AM Iraya, M Isaacs, M Isiguzo, A Issoufou, P Izquirdo, A Jaber, UV Jaganath, CS Jallow, S Jamabo, ZS Jamal, L Janneh, MJ Jannetjies, I Jasim, Megan AJ Jaworska, S Jay Narain, K Jermi, R Jimoh, S Jithoo, M Johnson, S Joomye, RM Judicael, M Judicaël, A Juwid, LP Jwambi, R Kabango, JK Kabangu, DK Kabatoro, AN Kabongo, K Kabongo, LT Kabongo, MD Kabongo, N Kady, S Kafu, M Kaggya, BNK Kaholongo, PCK Kairuki, SI Kakololo, K Kakudji, Amina Kalisa, R Kalisa, MR Kalufwelu, S Kalume, RJ Kamanda, MK Kangili, H Kanoun, null Kapesa, P Kapp, JK Karanja, M Karar, K Kariuki, K Kaseke, PNK Kashuupulwa, KJP Kasongo, SK Kassa, GK Kateregga, MIS Kathrada, PM Katompwa, L Katsukunya, KAM Kavuma, null Khalfallah, A Khamajeet, SB Khetrish, null Kibandwa, W Kibochi, AM Kilembe, AK Kintu, B Kipng'etich, B Kiprop, VMK Kissoon, Theroshnie K Kisten, JK Kiwanuka, MEK Knox, AK Koledale, VL Koller, MA Kolotsi, M Kongolo, ND Konwuoh, WJ Koperski, MYK Koraz, AA Kornilov, M Zach Koto, Samantha Kransingh, D Krick, S Kruger, C Kruse, W Kuhn, WP Kuhn, AM Kukembila, KL Kule, M Kumar, Belinda S Kusel, VK Kusweje, KJ Kuteesa, YY Kutor, MA Labib, M Laksari, F Lanos, TA Lawal, C Lee, RM Lekoloane, SN Lelo, B Lerutla, MT Lerutla, AI Levin, TB Likongo, ML Limbajee, DM Linyama, C Lionnet, MM Liwani, E Loots, A Garrido Lopez, CLC Lubamba, KF Lumbala, AJM Lumbamba, John Lumona, RF Lushima, L Luthuli, HL Luweesi, TSK Lyimo, HM Maakamedi, BM Mabaso, M Mabina, ME Maboya, I Macharia, AM Macheka, AZ Machowski, ASM Madsen, Farai Madzimbamuto, LJ Madzivhe, SC Mafafo, M Maghrabi, Diango Djibo Mahamane, A Maharaj, AD Maharaj, MR Mahmud, M Mahoko, NA Mahomedy, O Mahomva, TM Mahureva, RK Maila, DM Maimane, M Maimbo, SN Maina, Dela A Maiwald, MD Maiyalagan, N Majola, N Makgofa, V Makhanya, WP Makhaye, NM Makhlouf, S Makhoba, EK Makopa, O Makori, Alex M Makupe, MA Makwela, ME Malefo, SM Malongwe, DM Maluleke, MR Maluleke, K Touré Mamadou, MP Mamaleka, Y Mampangula, RM Mamy, MNR Mananjara, MTM Mandarry, DM Mangoo, C Manirimbere, A Manneh, A Mansour, I Mansour, M Manvinder, DV Manyere, VT Manzini, JK Manzombi, PM Mapanda, LC Marais, O Maranga, JPB Maritz, FK Mariwa, RS Masela, MM Mashamba, Doreen M Mashava, MV Mashile, E Mashoko, OR Masia, JN Masipa, ATM Masiyambiri, MW Matenchi, W Mathangani, RC Mathe, Christopher Y Matola, PM Matondo, R Matos-Puig, FFH Matoug, JT Matubatuba, HP Mavesere, R Mavhungu, S Maweni, CJM Mawire, T Mawisa, S Mayeza, R Mbadi, M Mbayabu, N Mbewe, WD Mbombo, T Mbuyi, WMS Mbuyi, MW Mbuyisa, RM Mehyaoui, ID Menkiti, LVM Mesarieki, A Metali, Serge Mewanou, L Mgonja, N Mgoqo, S Mhatu, TM Mhlari, S Miima, IM Milod, P Minani, F Mitema, A Mlotshwa, JE Mmasi, T Mniki, BO Mofikoya, JO Mogale, A Mohamed, S Mohamed, TS Mohamed, AM Mohamed, P Mohamed, I Mohammed, FAM Mohammed, M Mohammed, NM Mohammed, MP Mohlala, R Mokretar, FM Molokoane, KN Mongwe, L Montenegro, OD Montwedi, QK Moodie, M Moopanar, M Morapedi, TG Morulana, VL Moses, P Mossy, H Mostafa, SR Motilall, SP Motloutsi, Kanté Moussa, M Moutari, OM Moyo, PE Mphephu, Busi Mrara, C Msadabwe, VM Mtongwe, FK Mubeya, K Muchiri, J Mugambi, GIM Muguti, AB Muhammad, IF Mukama, MM Mukenga, FK Mukinda, PM Mukuna, ARW Mungherera, TW Munyaradzi, AA Munyika, JM Muriithi, MP Muroonga, R Murray, VK Mushangwe, M Mushaninga, VEM Musiba, JM Musowoya, S Mutahi, MGH Mutasiigwa, G Mutizira, A Muturi, T Muzenda, KR Mvwala, NM Mvwama, A Mwale, CN Mwaluka, JD Mwamba, HAM Mwanga, CM Mwangi, S Mwansa, V Mwenda, IM Mwepu, TM Mwiti, SZ Mzezewa, L Nabela, MTN Nabukenya, SM Nabulindo, K Naicker, D Naidoo, L Naidoo, LC Naidoo, N Naidoo, R Naidoo, RD Naidoo, S Naidoo, TD Naidoo, TK Naidu, NZ Najat, Y Najm, F Nakandungile, P Nakangombe, CN Namata, ES Namegabe, A Nansook, NP Nansubuga, C Nantulu, Rodrigue Nascimento, GT Naude, H Nchimunya, MA Ndaie, PN Ndarukwa, D Ndegwa, R Ndikumana, Andrew KN Ndonga, C Ndung'u, MC Neil, MS Nel, EV Neluheni, DS Nesengani, NT Nesengani, LE Netshimboni, AM Ngalala, BM Ngari, NBM Ngari, E Ngatia, GK Ngcobo, TS Ngcobo, D Ngorora, D Ngouane, K Ngugi, Zipporah WW Ngumi, Z Nibe, E Ninise, JC Niyondiko, PW Njenga, MN Njenga, M Njoroge, S Njoroge, W Njuguna, PN Njuki, T Nkesha, TN Nkuebe, NP Nkuliyingoma, M Nkunjana, Ernest Nkwabi, RN Nkwine, C Nnaji, I Notoane, Shaaban Nsalamba, LM Ntlhe, C Ntoto, B Ntueba, MT Nyassi, Z Nyatela-Akinrinmade, HO Nyawanda, NN Nyokabi, VN Nziene, S Obadiah, OJP Ochieng, PK Odia, OEO Oduor, EO Ogboli-Nwasor, SWO Ogendo, O Ogunbode, TO Ogundiran, O Ogutu, RW Ojewola, M Ojujo, DO Ojuka, OS Okelo, S Okiya, N Okonu, PR Olang, S Omoding, J Omoshoro-Jones, R Onyango, A Onyegbule, O Orjiako, MO Osazuwa, Kpatinvo Oscar, BB Osinaike, AO Osinowo, OM Othin, FFH Otman, J Otokwala, F Ouanes, Ongoïba Oumar, AO Ousseini, S Padayachee, SM Pahlana, J Pansegrouw, FP Paruk, MB Patel, Ushmaben Patel, AP Patience, JD Pembe, GN Pengemale, N Perez, MF Aguilera Perez, A Mallier Peter, M Phaff, RM Pheeha, BH Pienaar, V Pillay, KA Pilusa, MP Pochana, O Polishchuk, Owen S Porrill, EF Post, A Prosper, M Pupyshev, A Rabemazava, MS Rabiou, L Rademan, M Rademeyer, RAR Raherison, FR Rajah, MSR Rajcoomar, Z Rakhda, AHR Rakotoarijaona, AHN Rakotoarisoa, RR Rakotoarison, L Ramadan, MLR Ramananasoa, M Rambau, TPR Ramchurn, HE Ramilson, Rajesh J Ramjee, H Ramnarain, R Ramos, TJ Rampai, SR Ramphal, T Ramsamy, R Ramuntshi, R Randolph, DMA Randriambololona, WAP Ras, RAF Rasolondraibe, JDLC Rasolonjatovo, RM Rautenbach, S Ray, Sarah R Rayne, FAR Razanakoto, SR Reddy, Anthony R Reed, JR Rian, FR Rija, B Rink, AT Robelie, CA Roberts, AGL Rocher, S Rocher, Reitze N Rodseth, I Rois, W Rois, S Rokhsi, J Roos, Nicolette F Rorke, H Roura, FJ Rousseau, N Rousseau, L Royas, D Roytowski, Devan Rungan, SSR Rwehumbiza, BB Ryabchiy, V Ryndine, CR Saaiman, HK Sabwa, S Sadat, SS Saed, E Salaheddin, H Salaou, M Saleh, HM Salisu-Kabara, W Sam-Awortwi (Jnr), N Samuel, DK Sanduku, LN Sanyang, HN Sarah, A Sarkin-Pawa, R Sathiram, T Saurombe, H Schutte, MP Sebei, MD Sedekounou, MP Segooa, EM Semenya, BO Semo, CS Sendagire, SA Senoga, FS Senusi, T Serdyn, MD Seshibe, GB Shah, R Shamamba, CS Shambare, TN Shangase, SH Shanin, IE Shefren, AA Sheshe, OB Shittu, AS Shkirban, T Sholadoye, A Shubba, N Sigcu, SE Sihope, DS Sikazwe, BS Sikombe, K Simaga Abdoul, WAG Simo, K Singata, AS Singh, S Singh, Usha Singh, V Sinoamadi, N Sipuka, NLM Sithole, S Sitima, David Lee Skinner, GC Skinner, OI Smith, CAG Smits, MSI Sofia, Gaoussou Sogoba, A Sohoub, SS Sookun, O Sosinska, Rosalie Souhe, G Souley, Thiam Souleymane, JM Spicer, Sandra Spijkerman, H Steinhaus, A Steyn, G Steyn, HC Steyn, Heidi L Stoltenkamp, S Stroyer, A Swaleh, E Swayeb, AJ Szpytko, NA Taiwo, A Tarhuni, D Tarloff, Blaise Tchaou, Charles Tchegnonsi, M Tchoupa, MO Teeka, B Thakoor, MM Theunissen, BP Thomas, MB Thomas, A Thotharam, O Tobiko, AM Torborg, SM Tshisekedi, SK Tshisola, R Tshitangano, F Tshivhula, HT Tshuma, Janat Tumukunde, M Tun, IA Udo, DI Uhuebor, KU Umeh, AO Usenbo, JdD Uwiteyimbabazi, DJ Van der Merwe, FH van der Merwe, JE van der Walt, Dominique van Dyk, JG Van Dyk, JJS van Niekerk, S van Wyk, HA van Zyl, B Veerasamy, PJ Venter, AJ Vermeulen, R Villarreal, J Visser, L Visser, M Voigt, Richard P von Rahden, A Wafa, A Wafula, PK Wambugu, P Waryoba, EN Waweru, M Weideman, Robert D Wise, EE Wynne, AI Yahya, AA Yahya, R Yahya, Y Yakubu, JJ Yanga, YM Yangazov, O Yousef, G Yousef, AA Yunus, AS Yusuf, AZ Zeiton, HZ Zentuti, Henry Zepharine, AB Zerihun, S Zhou, A Zidan, Sanogo Zimogo Zié, CZ Zinyemba, A Zo, Lidwine Zomahoun, NZ Zoobei, Eugene Zoumenou, NZ Zubia, and Supporting clinical sciences
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Male ,Postoperative Complications/epidemiology ,030230 surgery ,Global Health ,Severity of Illness Index ,Neurosurgical Procedures ,Postoperative Complications ,0302 clinical medicine ,Gynecologic Surgical Procedures ,030202 anesthesiology ,Outcome Assessment, Health Care ,Medicine ,Orthopedic Procedures ,Postoperative Period ,Prospective Studies ,Young adult ,Prospective cohort study ,Digestive System Surgical Procedures ,Surgical Wound Infection/epidemiology ,education.field_of_study ,General Medicine ,Middle Aged ,Hospitals ,Surgical Procedures, Operative ,Cohort studies ,Urologic Surgical Procedures ,young adult ,Female ,pregnancy ,Vascular Surgical Procedures ,Cohort study ,Adult ,medicine.medical_specialty ,Population ,Lower risk ,03 medical and health sciences ,Outcome Assessment (Health Care) ,Severity of illness ,Surgical Wound Infection ,Humans ,Cardiac Surgical Procedures ,Mortality ,education ,business.industry ,Cesarean Section ,Perioperative ,Thoracic Surgical Procedures ,Logistic Models ,Africa/epidemiology ,Africa ,Emergency medicine ,Observational study ,business - Abstract
Summary 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.
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- 2018