SummaryDeaths following surgery are the third largest contributor to deaths globally, and in Africa are twice the global average. There is a need for a peri‐operative research agenda to ensure co‐ordinated, collaborative research efforts across Africa in order to decrease peri‐operative mortality. The objective was to determine the top 10 research priorities for peri‐operative research in Africa. A Delphi technique was used to establish consensus on the top research priorities. The top 10 research priorities identified were (1) Develop training standards for peri‐operative healthcare providers (surgical, anaesthesia and nursing) in Africa; (2) Develop minimum provision of care standards for peri‐operative healthcare providers (surgical, anaesthesia and nursing) in Africa; (3) Early identification and management of mothers at risk from peripartum haemorrhage in the peri‐operative period; (4) The role of communication and teamwork between surgical, anaesthetic, nursing and other teams involved in peri‐operative care; (5) A facility audit/African World Health Organization situational analysis tool audit to assess emergency and essential surgical care, which includes anaesthetic equipment available and level of training and knowledge of peri‐operative healthcare providers (surgeons, anaesthetists and nurses); (6) Establishing evidence‐based practice guidelines for peri‐operative physicians in Africa; (7) Economic analysis of strategies to finance access to surgery in Africa; (8) Establishment of a minimum dataset surgical registry; (9) A quality improvement programme to improve implementation of the surgical safety checklist; and (10) Peri‐operative outcomes associated with emergency surgery. These peri‐operative research priorities provide the structure for an intermediate‐term research agenda to improve peri‐operative outcomes across Africa.

Diabetes mellitus (DM) is a common condition, affecting an estimated 15.5 million people in Africa. Importantly, the prevalence of DM across the continent is expected to double by 2045. [1] Since 2015, this condition has been ranked as the second most common cause of natural death in South Africa (SA), and its impact on healthcare provision is substantial. [2] Accurate assessment of prevalence is difficult owing to the high burden of undiagnosed DM (estimated at 69% in Africa) and the lack of large population studies. [1] In SA, the prevalence of DM is estimated to be between 5.4% and 9.2%. [1,3] There are limited data reporting the prevalence of DM in Western Cape Province, SA, and information with regard to elective surgical patients is minimal. Many studies have shown that DM, especially if poorly controlled, is associated with an increased risk of perioperative complications and mortality. [4-9] In SA, insulin-dependent surgical patients are twice as likely as non-diabetics to die in hospital. [10] Objectives The primary objective of this study was to establish the prevalence of DM in patients presenting for elective surgery over a 1-week period in six Western Cape hospitals. This included patients with a previous diagnosis of DM, and those with a new diagnosis based on screening capillary blood glucose (CBG) testing and a confirmatory elevated glycated haemoglobin (HbA1c) level. The secondary objectives were to assess: (i) the glycaemic control of known diabetics presenting for This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

In high-income countries, preoperative anaemia has been associated with increased postoperative morbidity and mortality. [1] Preoperative anaemia is a common problem, with three large database studies in Europe and America estimating the prevalence to be between 25% and 30%. [2-4] Anaemia is also associated with increased perioperative blood transfusions, a practice independently associated with morbidity and mortality. [5] Growing evidence supports increasingly restrictive transfusion strategies in surgical and critical care patients, and as a result allogeneic transfusions can no longer be considered an appropriate isolated management strategy for surgical patients with preoperative anaemia. [6,7] Furthermore, the demographics of the South African (SA) surgical population differ significantly from those of the populations in which the morbidity associated with preoperative anaemia has been described. SA non-cardiac surgical patients are younger, have fewer non-communicable diseases, and undergo significantly more urgent and emergency This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However, randomised evidence of the efficacy of the SSC at rural hospital level is absent.

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Background. Fasting for liquids and solids is recommended prior to procedures requiring anaesthesia, to reduce the risk of pulmonary aspiration. Children often experience excessive fasting, which is associated with negative physiological and behavioural consequences, and patient discomfort. The duration of preoperative fasting in children in South Africa (SA) is unknown. Objectives. To determine compliance with fasting guidelines and fasting times of children prior to elective procedures performed under anaesthesia at a paediatric hospital in Cape Town, SA. The primary focus was fasting for clear liquid. We also intended to identify the most common reasons for prolonged clear liquid fasting. Methods. Over a 7-week period, we prospectively captured fasting times of consecutive patients undergoing elective surgical, medical and radiological procedures at Red Cross War Memorial Children's Hospital. Measurement outcomes were defined as the period from the last clear liquid, milk or solid feed to the start of anaesthesia. For analysis of compliance with preoperative fasting guidelines, institutional preoperative fasting target limits were established based on the standard 6-4-2-hour guideline.Results. The study included 721 elective paediatric cases. The mean (standard deviation (SD)) fasting time for clear liquids (n=585) was 8.0 (4.8) hours, with an adherence rate of 25.5% (95% confidence interval 22 -29) to the institutional target of 2 -4 hours. The mean (SD) fasting times for breastmilk (n=92), formula milk (n=116) and solid feeds (n=560) were 7.1 (2.8), 8.8 (2.8) and 13.9 (3.6) hours, respectively. The factors associated with clear liquid fasting >4 hours were inadequate fasting instructions, poor adherence to fasting orders, procedural delays and fasting to promote theatre flexibility. Conclusions. This study demonstrates that children in an SA hospital experience excessive fasting times prior to elective procedures. To reduce fasting durations and improve the quality of perioperative care, quality improvement interventions are required to create an adaptable fasting system that allows individualised fasting. Improving preoperative fasting times in children is the responsibility of all healthcare professionals in the multidisciplinary management team.

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Background: Vascular surgical patients have an elevated cardiac risk following non-cardiac surgery. The decision whether to proceed with surgery is multidimensional. Patients must balance the considerations in favour of surgery with those favouring conservative treatment, which requires weighing peri-operative risk against morbidity associated with non-surgical treatment. Methods: The aim of this prospective correlational study was to determine the proportional contributions of (i) pain, (ii) impulsivity, (iii) patients' perception of the benefits of surgery, (iv) patients' perception of peri-operative risk and (v) the predicted peri-operative risk on acceptance of peri-operative risk by vascular surgical patients. Sixty patients were prospectively recruited by convenience sampling from the Inkosi Albert Luthuli Central Hospital vascular surgery clinic between April 2014 and June 2014. Written informed consent was obtained. Patients completed a questionnaire which documented demographics, pain assessment, impulsivity screen (Barratt Impulsiveness Scale 11), patients' perception of surgery, predicted peri-operative risk (South African Vascular Surgical Cardiac Risk Index) and acceptance of peri-operative risk. Data were analysed using descriptive statistics and linear regression (SPSS version 22). Results: The patients' perception of the benefits of surgery (β 0.36, 95% CI 0.14-0.70, p = 0.005) was the only predictor of peri-operative risk acceptance. The associations between the other potential predictors and the outcome were insignificant. Conclusion:The perceived benefit of surgery was the most important predictor of acceptance of peri-operative risk in this cohort.Keywords: pain, peri-operative risk, shared decision-making, vascular surgery There has been a global increase in the number of patients undergoing non-cardiac surgery with an estimated 500 000 to 900 000 patients experiencing peri-operative cardiac events annually. 1,2Vascular surgical patients have an increased cardiac risk following non-cardiac surgery and a high coexistent morbidity. The dilemma that these patients face involves balancing the risks and benefits associated with surgery against those of conservative management, which includes considering the peri-operative risk associated with the surgery (cardiac death, nonfatal myocardial infarction and nonfatal cardiac arrest) against the associated consequences without the surgery (intractable pain, limited mobility and death). 2−5Decision-making is a cognitive process that requires reflection on the consequences of a choice and deliberation on alternatives and contemplation of future outcomes. 6,7 Patient autonomy and readiness to give informed consent for surgery are affected by several factors. 8 The aim of this study was to determine the proportional contributions of (i) pain, (ii) impulsivity, (iii) patients' perception of the benefits of surgery, (iv) patients' perception of peri-operative risk and (v) predicted peri-operative risk on the acceptance of peri-operative risk by vascular sur...