Avoidable perioperative mortality at the University Teaching Hospital, Lusaka, Zambia: a retrospective cohort study

Lillie, Edwardina Mary Mae Alexandra; Holmes, Christopher J.; O’Donohoe, Elizabeth Anne; Bowen, Lowri; Ngwisha, Chadwick L. T.; Ahmed, Yusuf; Snell, David; Kinnear, John; Bould, M. Dylan

doi:10.1007/s12630-015-0483-z

Cited by 21 publications

(16 citation statements)

References 7 publications

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“…Indeed, the Lancet Commission on Global Surgery includes development of critical care as an essential aspect of improving overall peri‐operative facilities . A previous study identified lack of availability of ICU beds and equipment as a possible contributing factor in avoidable peri‐operative mortality at UTH . At the time of the study, the UTH ICU casemix showed a predominance of medical over surgical patients.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of inpatient morbidity and critical care provision in Zambia

et al. 2016

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Summary The aim of this study was to objectively measure demand for critical care services in a southern African tertiary referral centre. We carried out a point prevalence study of medical and surgical admissions over a 48‐h period at the University Teaching Hospital, Lusaka, recording the following: age; sex; diagnosis; Human Immunodeficiency Virus (HIV) status and National Early Warning Score. One‐hundred and twenty medical and surgical admissions were studied. Fifty‐four patients (45%) had objective evidence of a requirement for critical care review and potential or probable admission to an intensive care unit, according to the Royal College of Physicians (UK) guidelines. A greater than expected HIV rate was also noted; 53 of 75 tested patients (71%). When applied to the estimated 17,496 annual acute admissions, this would equate to 7873 patients requiring critical care input annually at this hospital alone. In contrast to this demand, we identified 109 critical care beds nationally, and only eight at this institution.

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Section: Discussionmentioning

confidence: 99%

An evaluation of inpatient morbidity and critical care provision in Zambia

et al. 2016

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“…Perioperative morbidity and mortality in the emergency surgical setting is significant in Zambia. A 2012 study of 18,010 surgical patients reported that 114 (0.6%) patients had died by postoperative day 6 5 ; 30% of deaths were avoidable, 32% were ''probably'' avoidable, and failure to recognize the deteriorating patient was often a key factor in avoidable death. 5 In a resource-limited environment, the early identification of critically ill patients is likely to be key to allowing appropriate resource allocation in a timely fashion.…”

mentioning

confidence: 99%

Four early warning scores predict mortality in emergency surgical patients at University Teaching Hospital, Lusaka: a prospective observational study

Foy

Pearson

Kettley

et al. 2019

Can J Anesth/J Can Anesth

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The value of early warning scoring systems has been established in high-income countries. There is little evidence for their use in low-resource settings. We aimed to compare existing early warning scores to predict 30-day mortality. Methods University Teaching Hospital is a tertiary center in Lusaka, Zambia. Adult surgical patients, excluding obstetrics, admitted for [ 24 hr were included in this prospective observational study. On days 1 to 3 of admission, we collected data on patient demographics, heart rate, blood pressure, oxygen saturation, oxygen administration, temperature, consciousness level, and mobility. Two-, three-, and 30-day mortality were recorded with their associated variables analyzed using area under receiver operating curves (AUROC) for the National Early Warning Score (NEWS); the Modified Early Warning Score (MEWS); a modified Hypotension, Oxygen Saturation, Temperature, ECG, Loss of Independence (mHOTEL) score; and the Tachypnea, Oxygen saturation, Temperature, Alertness, Loss of Independence (TOTAL) score. Results Data were available for 254 patients from March 2017 to July 2017. Eighteen (7.5%) patients died at 30 days. The four early warning scores were found to be predictive of 30-day mortality: MEWS (AUROC, 0.76; 95% confidence interval [CI], 0.63 to 0.88; P \ 0.001), NEWS (AUROC 0.805; 95% CI, 0.688 to 0.92; P \ 0.001), mHOTEL (AUROC 0.759; 95% CI, 0.63 to 0.89, P \ 0.001), and TOTAL (AUROC 0.782; 95% CI, 0.66 to 0.90; P \ 0.001). Conclusions We validated four scoring systems in predicting mortality in a Zambian surgical population. Further work is required to assess if implementation of these scoring systems can improve outcomes. Résumé Objectif L'utilité des scores d'évaluation d'alerte précoce a été établie dans les pays à revenu élevé. Il n'existe que peu de données probantes concernant leur utilisation dans les contextes de faibles ressources. Nous avons tenté de comparer les scores d'évaluation d'alerte précoce

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“…To the Editor, I read with great interest the recent editorial by Dr. Weiser et al 1 that referred to an accompanying report describing research on avoidable perioperative mortality in Zambia. 2 They emphasized the need to measure the results of health care delivered, especially when reporting on populations undergoing various types of surgical procedures.…”

mentioning

confidence: 99%

Lack of data on standardized metrics for surgical care in a developing country with middle total expenditure on health

Zapata

2016

Can J Anesth/J Can Anesth

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Avoidable perioperative mortality at the University Teaching Hospital, Lusaka, Zambia: a retrospective cohort study

Cited by 21 publications

References 7 publications

An evaluation of inpatient morbidity and critical care provision in Zambia

An evaluation of inpatient morbidity and critical care provision in Zambia

Four early warning scores predict mortality in emergency surgical patients at University Teaching Hospital, Lusaka: a prospective observational study

Lack of data on standardized metrics for surgical care in a developing country with middle total expenditure on health

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