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Lancet. 2018 Apr 21;391(10130):1589-1598. doi: 10.1016/S0140-6736(18)30001-1. Epub 2018 Jan 3.

Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

Collaborators (1060)

Abadagan H, Abbas N, Abdelatif AI, Abdoulaye T, Abd-Rouf A, Abduljalil A, Abdulrahman A, Abdurazig S, Abokris A, Abozaid W, Abugassa S, Abuhdema F, Abujanah SA, Abusamra R, Abushnaf A, Abusnina SA, Abuzalout TS, Ackermann HM, Adamu YB, Addanfour A, Adeleke DM, Adigun TA, Adisa AO, Adjignon SV, Adu-Aryee NA, Afolabi BB, Agaba A, Agaba P, Aghadi K, Agilla H, Ahmed B, Ahmed EZ, Ahmed AJ, Ahmed M, Ahossi R, Aji SA, Akanyun S, Akhideno I, Akhter M, Akinyemi OA, Akkari M, Akodjenou J, Al Samateh AL, Al Shams ES, Alagbe-Briggs OT, Alakkari EA, Alalem RB, Alashhab M, Alatise OI, Alatresh A, Alayeb Alayeb M, Albakosh BA, Albert F, Alberts A, Aldarrat AD, Alfari A, Alfetore A, Algbali M, Algddar A, Algedar HA, Alghafoud IA, Alghazali A, Alhajj M, Alhendery Alhendery A, Alhoty F, Ali A, Ali YA, Ali A, Alioune BS, Alkassem MA, Alkchr MA, Alkesa TS, Alkilani A, Alkobty Alkobty F, Allaye T, Alleesaib S, Alli A, Allopi K, Allorto NL, Almajbery A, Almesmary R, Almisslati S, Almoraid F, Alobeidi H, Alomami MA, Alphonsus CS, Alqawi OA, Alraheem AA, Alsabri SA, Alsayed A, Alsellabi B, Al-Serksi M, Alshareef M, Altagazi AA, Aluvale JS, Alwahedi HW, Alzahra EA, Alzarouk MA, Al-Zubaidy K, Amadou M, Amadou M, Amanor-Boadu SD, Amer AA, Amisi BT, Amuthenu MA, Anabah T, Anani F, Anderson P, Andriamampionona A, Andrianina L, Anele A, Angelin R, Anjar N, Antùnez O, Antwi-Kusi A, Anyanwu L, Aribi AA, Arowolo OA, Arrey O, Ashebir DZ, Assefa SB, Assoum G, Athanse V, Athombo JS, Atiku M, Atito-Narh E, Atomabe A, Attia A, Aungraheeta M, Aurélia D, Ayandipo OO, Ayebale A, Azzaidey H, Babajee NB, Badi HB, Badianga EK, Baghni RB, Bahta MT, Bai M, Baitchu Y, Baloyi AM, Bamuza KA, Bamuza MI, Bangure L, Bankole OB, Barongo ML, Barow MM, Basenero A, Bashiya L, Basson CH, Bechan S, Belhaj S, Ben Mansour MM, Benali D, Benamour A, Berhe A, Bertie JD, Bester J, Bester M, Bezuidenhout JD, Bhagwan K, Bhagwandass DR, Bhat K, Bhuiyan M, Biccard BM, Bigirimana F, Bikuelo CJ, Bilby BE, Bingidimi SS, Bischof KE, Bishop DG, Bitta C, Bittaye M, Biyase T, Blake CA, Blignaut E, Blignaut F, Bn Tanjong BN, Bogoslovskiy A, Boloko PM, Boodhun S, Bori I, Boufas F, Brand M, Brouckaert NT, Bruwer JD, Buccimazza I, Bula Bula IM, Bulamba F, Businge BC, Bwambale YB, Cacala S, Cadersa MA, Cairns C, Carlos F, Casey ME, Castro AC, Chabayanzara ND, Chaibou MS, Chaibva T, Chakafa NK, Chalo C, Changfoot C, Chari MC, Chelbi L, Chibanda JT, Chifamba HN, Chikh N, Chikumba E, Chimberengwa P, Chirengwa J, Chitungo FM, Chiwanga MC, Chokoe MM, Chokwe TM, Chrirangi B, Christian M, Church B, Cisekedi JC, Clegg-Lamptey JN, Cloete E, Coltman M, Conradie W, Constance N, Coulibaly Y, Cronje L, Da Silva MA, Daddy H, Dahim L, Daliri D, Dambaki MS, Dasrath A, Davids JG, Davies GL, De Lange JT, de Wet JB, Dedekind B, Degaulle MA, Dehal V, Deka PD, Delinikaytis S, Desalu IS, Dewanou H, Deye MM, Dhege C, Diale B, Dibwe DF, Diedericks B, Dippenaar JM, Dippenaar L, Diyoyo MP, Djessouho E, Dlamini SN, Dodiyi-Manuel A, Dokolwana BA, Domoyyeri DP, Drummond LW, du Plessis DE, du Plessis WM, du Preez LJ, Dube K, Dube NZ, Dullab KD, Duvenhage R, Echem RC, Edaigbini SA, Egote AK, Ehouni A, Ekwen G, Ekwunife NC, El Hensheri M, Elfaghi IE, Elfagieh MA, Elfallah S, Elfiky M, Elgelany S, Elghallal AM, Elghandouri MG, Elghazal ZS, Elghobashy AM, Elharati FT, Elkhogia AM, Elkhwildi RM, Ellis S, Elmadani L, Elmadany HB, Elmehdawi H, Elmgadmi A, Eloi H, Elrafifi D, Elsaadi G, Elsaity RB, Elshikhy A, Eltaguri M, Elwerfelli A, Elyasir IE, Elzoway AZ, Elzufri AM, Enendu EO, Enicker BC, Enwerem EO, Esayas R, Eshtiwi M, Eshwehdi AA, Esterhuizen JL, Esterhuizen TM, Etuk EB, Eurayet O, Eyelade OR, Fanjandrainy RF, Fanou L, Farina Z, Fawzy M, Feituri A, Fernandes NL, Ford LM, Forget P, François T, Freeman T, Freeman Y, Gacii VM, Gadi B, Gagara M, Gakenia A, Gallou PD, Gama G, Gamal MG, Gandy YG, Ganesh A, Gangaly D, Garcia M, Gatheru AP, Gaya S, Gbéhadé O, Gerbel G, Ghnain A, Gigabhoy R, Giles DG, Girmaye GT, Gitau S, Githae B, Gitta S, Gobin V, Goga R, Gomati A, Gonzalez ME, Gopall J, Gordon CS, Gorelyk O, Gova M, Govender K, Govender P, Govender S, Govindasamy V, Green-Harris J, Greenwood MB, Grey-Johnson SV, Grobbelaar M, Groenewald MA, Grünewald KK, Guegni A, Guenane M, Gueye S, Guezo M, Gunguwo T, Gweder MG, Gwila M, Habimana L, Hadecon R, Hadia E, Hamadi L, Hammouda M, Hampton MI, Hanta R, Hardcastle TC, Hariniaina JA, Hariparsad S, Harissou AH, Harrichandparsad R, Hasan S, Hashmi HB, Hayes MP, Hdud A, Hebli SH, Heerah H, Hersi S, Hery AH, Hewitt-Smith A, Hlako TC, Hodges S, Hodgson RE, Hokoma M, Holder H, Holford EB, Horugavye E, Houston C, Hove M, Hugo D, Human CM, Hurri H, Huwidi O, Ibrahim AI, Ibrahim T, Idowu OK, Igaga IE, Igenge J, Ihezie O, Ikandi K, Ike I, Ikuku J, Ilbarasi MN, Ilunga I, Ilunga J, Imbangu N, Imessaoudene Z, Imposo DH, Iraya AM, Isaacs M, Isiguzo M, Issoufou A, Izquirdo P, Jaber A, Jaganath UV, Jallow CS, Jamabo S, Jamal ZS, Janneh L, Jannetjies MJ, Jasim I, Jaworska MA, Jay Narain S, Jermi K, Jimoh R, Jithoo S, Johnson M, Joomye S, Judicael RM, Judicaël M, Juwid A, Jwambi LP, Kabango R, Kabangu JK, Kabatoro DK, Kabongo AN, Kabongo K, Kabongo LT, Kabongo MD, Kady N, Kafu S, Kaggya M, Kaholongo B, Kairuki P, Kakololo SI, Kakudji K, Kalisa A, Kalisa R, Kalufwelu MR, Kalume S, Kamanda RJ, Kangili MK, Kanoun H, Kapesa, Kapp P, Karanja JK, Karar M, Kariuki K, Kaseke K, Kashuupulwa P, Kasongo K, Kassa SK, Kateregga GK, Kathrada M, Katompwa PM, Katsukunya L, Kavuma K, Khalfallah, Khamajeet A, Khetrish SB, Kibandwa, Kibochi W, Kilembe AM, Kintu AK, Kipng'etich B, Kiprop B, Kissoon V, Kisten TK, Kiwanuka JK, Kluyts HL, Knox M, Koledale AK, Koller VL, Kolotsi MA, Kongolo M, Konwuoh ND, Koperski WJ, Koraz M, Kornilov AA, Koto MZ, Kransingh S, Krick D, Kruger S, Kruse C, Kuhn W, Kuhn WP, Kukembila AM, Kule KL, Kumar M, Kusel BS, Kusweje VK, Kuteesa KJ, Kutor YY, Labib MA, Laksari M, Lanos F, Lawal TA, Le Manach Y, Lee C, Lekoloane RM, Lelo SN, Lerutla B, Lerutla MT, Levin AI, Likongo TB, Limbajee ML, Linyama DM, Lionnet C, Liwani MM, Loots E, Lopez AG, Lubamba C, Lumbala KF, Lumbamba A, Lumona J, Lushima RF, Luthuli L, Luweesi HL, Lyimo T, Maakamedi HM, Mabaso BM, Mabina M, Maboya ME, Macharia I, Macheka AM, Machowski AZ, Madiba TE, Madsen A, Madzimbamuto F, Madzivhe LJ, Mafafo SC, Maghrabi M, Mahamane DD, Maharaj A, Maharaj A, Maharaj AD, Mahmud MR, Mahoko M, Mahomedy NA, Mahomva O, Mahureva TM, Maila RK, Maimane DM, Maimbo M, Maina SN, Maiwald DA, Maiyalagan MD, Majola N, Makgofa N, Makhanya V, Makhaye WP, Makhlouf NM, Makhoba S, Makopa EK, Makori O, Makupe AM, Makwela MA, Malefo ME, Malongwe SM, Maluleke DM, Maluleke MR, Mamadou KT, Mamaleka MP, Mampangula Y, Mamy RM, Mananjara M, Mandarry M, Mangoo DM, Manirimbere C, Manneh A, Mansour A, Mansour I, Manvinder M, Manyere DV, Manzini VT, Manzombi JK, Mapanda PM, Marais LC, Maranga O, Maritz J, Mariwa FK, Masela RS, Mashamba MM, Mashava DM, Mashile MV, Mashoko E, Masia OR, Masipa JN, Masiyambiri A, Matenchi MW, Mathangani W, Mathe RC, Matola CY, Matondo PM, Matos-Puig R, Matoug F, Matubatuba JT, Mavesere HP, Mavhungu R, Maweni S, Mawire C, Mawisa T, Mayeza S, Mbadi R, Mbayabu M, Mbewe N, Mbombo WD, Mbuyi T, Mbuyi W, Mbuyisa MW, Mbwele B, Mehyaoui RM, Menkiti ID, Mesarieki L, Metali A, Mewanou S, Mgonja L, Mgoqo N, Mhatu S, Mhlari TM, Miima S, Milod IM, Minani P, Mitema F, Mlotshwa A, Mmasi JE, Mniki T, Mofikoya BO, Mogale JO, Mohamed A, Mohamed A, Mohamed A, Mohamed S, Mohamed S, Mohamed TS, Mohamed A, Mohamed A, Mohamed AM, Mohamed P, Mohammed I, Mohammed F, Mohammed M, Mohammed NM, Mohlala MP, Mokretar R, Molokoane FM, Mongwe KN, Montenegro L, Montwedi OD, Moodie QK, Moopanar M, Morapedi M, Morulana TG, Moses VL, Mossy P, Mostafa H, Motilall SR, Motloutsi SP, Moussa K, Moutari M, Moyo OM, Mphephu PE, Mrara B, Msadabwe C, Mtongwe VM, Mubeya FK, Muchiri K, Mugambi J, Muguti G, Muhammad AB, Mukama IF, Mukenga MM, Mukinda FK, Mukuna PM, Mungherera A, Munlemvo DM, Munyaradzi TW, Munyika AA, Muriithi JM, Muroonga MP, Murray R, Mushangwe VK, Mushaninga M, Musiba V, Musowoya JM, Mutahi S, Mutasiigwa M, Mutizira G, Muturi A, Muzenda T, Mvwala KR, Mvwama NM, Mwale A, Mwaluka CN, Mwamba JD, Mwanga H, Mwangi CM, Mwansa S, Mwenda V, Mwepu IM, Mwiti TM, Mzezewa SZ, Nabela L, Nabukenya M, Nabulindo SM, Naicker K, Naidoo D, Naidoo L, Naidoo LC, Naidoo N, Naidoo R, Naidoo RD, Naidoo S, Naidoo TD, Naidu TK, Najat NZ, Najm Y, Nakandungile F, Nakangombe P, Namata CN, Namegabe ES, Nansook A, Nansubuga NP, Nantulu C, Nascimento R, Naude GT, Nchimunya H, Ndaie MA, Ndarukwa PN, Ndasi H, Ndayisaba G, Ndegwa D, Ndikumana R, Ndonga AK, Ndung'u C, Neil MC, Nel MS, Neluheni EV, Nesengani DS, Nesengani NT, Netshimboni LE, Ngalala AM, Ngari BM, Ngari N, Ngatia E, Ngcobo GK, Ngcobo TS, Ngorora D, Ngouane D, Ngugi K, Ngumi ZW, Nibe Z, Ninise E, Niyondiko JC, Njenga PW, Njenga MN, Njoroge M, Njoroge S, Njuguna W, Njuki PN, Nkesha T, Nkuebe TN, Nkuliyingoma NP, Nkunjana M, Nkwabi E, Nkwine RN, Nnaji C, Notoane I, Nsalamba S, Ntlhe LM, Ntoto C, Ntueba B, Nyassi MT, Nyatela-Akinrinmade Z, Nyawanda HO, Nyokabi NN, Nziene VN, Obadiah S, Ochieng O, Odia PK, Oduor O, Ogboli-Nwasor EO, Ogendo S, Ogunbode O, Ogundiran TO, Ogutu O, Ojewola RW, Ojujo M, Ojuka DO, Okelo OS, Okiya S, Okonu N, Olang PR, Omigbodun AO, Omoding S, Omoshoro-Jones J, Onyango R, Onyegbule A, Orjiako O, Osazuwa MO, Oscar K, Osinaike BB, Osinowo AO, Othin OM, Otman F, Otokwala J, Ouanes F, Oumar O, Ousseini AO, Padayachee S, Pahlana SM, Pansegrouw J, Paruk FP, Patel MB, Patel U, Patience AP, Pearse RM, Pembe JD, Pengemale GN, Perez N, Perez MA, Peter AM, Phaff M, Pheeha RM, Pienaar BH, Pillay V, Pilusa KA, Pochana MP, Polishchuk O, Porrill OS, Post EF, Prosper A, Pupyshev M, Rabemazava A, Rabiou MS, Rademan L, Rademeyer M, Raherison R, Rajah FR, Rajcoomar M, Rakhda Z, Rakotoarijaona A, Rakotoarisoa A, Rakotoarison SR, Rakotoarison RR, Ramadan L, Ramananasoa M, Rambau M, Ramchurn T, Ramilson HE, Ramjee RJ, Ramnarain H, Ramos R, Rampai TJ, Ramphal SR, Ramsamy T, Ramuntshi R, Randolph R, Randriambololona D, Ras W, Rasolondraibe R, Rasolonjatovo J, Rautenbach RM, Ray S, Rayne SR, Razanakoto F, Reddy SR, Reed AR, Rian JR, Rija FR, Rink B, Robelie AT, Roberts CA, Rocher A, Rocher S, Rodseth RN, Rois I, Rois W, Rokhsi S, Roos J, Rorke NF, Roura H, Rousseau FJ, Rousseau N, Royas L, Roytowski D, Rungan D, Rwehumbiza S, Ryabchiy BB, Ryndine V, Saaiman CR, Sabwa HK, Sadat S, Saed SS, Salaheddin E, Salaou H, Saleh M, Salisu-Kabara HM, Sama HD, Samateh AL, Sam-Awortwi Jnr W, Samuel N, Sanduku DK, Sani CM, Sanyang LN, Sarah HN, Sarkin-Pawa A, Sathiram R, Saurombe T, Schutte H, Sebei MP, Sedekounou MD, Segooa MP, Semenya EM, Semo BO, Sendagire CS, Senoga SA, Senusi FS, Serdyn T, Seshibe MD, Shah GB, Shamamba R, Shambare CS, Shangase TN, Shanin SH, Shefren IE, Sheshe AA, Shittu OB, Shkirban AS, Sholadoye T, Shubba A, Sigcu N, Sihope SE, Sikazwe DS, Sikombe BS, Simaga Abdoul K, Simo W, Singata K, Singh AS, Singh S, Singh U, Sinoamadi V, Sipuka N, Sithole N, Sitima S, Skinner DL, Skinner GC, Smith OI, Smits C, Sofia M, Sogoba G, Sohoub A, Sookun SS, Sosinska O, Souhe R, Souley G, Souleymane T, Spicer JM, Spijkerman S, Steinhaus H, Steyn A, Steyn G, Steyn HC, Stoltenkamp HL, Stroyer S, Swaleh A, Swayeb E, Szpytko AJ, Taiwo NA, Tarhuni A, Tarloff D, Tchaou B, Tchegnonsi C, Tchoupa M, Teeka MO, Thakoor B, Theunissen MM, Thomas BP, Thomas MB, Thotharam A, Tobiko O, Torborg AM, Tshisekedi SM, Tshisola SK, Tshitangano R, Tshivhula F, Tshuma HT, Tumukunde J, Tun M, Udo IA, Uhuebor DI, Umeh KU, Usenbo AO, Uwiteyimbabazi J, Van der Merwe DJ, van der Merwe FH, van der Walt JE, van Dyk D, Van Dyk JG, van Niekerk J, van Wyk S, van Zyl HA, Veerasamy B, Venter PJ, Vermeulen AJ, Villarreal R, Visser J, Visser L, Voigt M, von Rahden RP, Wafa A, Wafula A, Wambugu PK, Waryoba P, Waweru EN, Weideman M, Wise RD, Wynne EE, Yahya AI, Yahya AA, Yahya R, Yakubu Y, Yanga JJ, Yangazov YM, Yousef O, Yousef G, Youssouf C, Yunus AA, Yusuf AS, Zeiton AZ, Zentuti HZ, Zepharine H, Zerihun AB, Zhou S, Zidan A, Zié SZ, Zinyemba CZ, Zo A, Zomahoun L, Zoobei NZ, Zoumenou E, Zubia NZ.

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.

PMID:
29306587
DOI:
10.1016/S0140-6736(18)30001-1
[Indexed for MEDLINE]

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