Image: Low-resource hospitals, such as this one in Senegal, contribute to Africa’s higher surgical death rate (Photo courtesy of IvuMed).
A new study reveals that despite a low-risk profile and few postoperative complications, patients in Africa are twice as likely to die compared to the worldwide norm.
Hundreds of researchers participating in the international African Surgical Outcomes Study (ASOS) conducted a prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa during a seven-day period. The researchers collected data from at least 10 hospitals per country. Each country selected one recruitment week between February and May 2016, with total study cohort including 11,422 patients from 247 hospitals during the national cohort weeks. The primary outcome was in-hospital postoperative complications, which were graded as mild, moderate, or severe.
The hospitals served a median population of 810,000 people, with the combined number of specialist surgeons, obstetricians, and anesthetists totaling 0.7 per 100,000. A median 212 surgical procedures per 10,000 patients were undertaken, with the African patients being younger and with a lower risk profile than in high-income countries. The most common elective surgical procedure was cesarean delivery (33%); postoperative complications occurred in 18.2% of the patients, and 2.1% died, the majority of them the day of surgery. Infection was the most common complication (10.2%), of which 9.7% died.
Comparisons with international data for elective surgery showed that death rates were one percent in Africa, compared with 0.5 percent for the global average. The authors suggested that a lack of crucial equipment and supplies hampered surgical care in Africa; a quarter of hospitals have no reliable oxygen source, a third do not have reliable electricity, and nearly half do not have dedicated postoperative care. The researchers stated that many lives could be saved by improving patient monitoring during and after surgery. The study was published on January 3, 2018, in The Lancet.
“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,” concluded lead author Professor Bruce Biccard, PhD, of the University of Cape Town (UCT; South Africa), and colleagues. “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.”
University of Cape Town