Incidence and predictors of perioperative mortality in a low-resource country, Ethiopia: a prospective follow-up study

Abstract

ObjectiveThis study aimed to assess the incidence and identify predictors of perioperative mortality among the adult age group at Tibebe Ghion Specialised Hospital.DesignA single-centre prospective follow-up study.SettingA tertiary hospital in North West Ethiopia.ParticipantsWe enrolled 2530 participants who underwent surgery in the current study. All adults aged 18 and above were included except those with no telephone.Primary outcome measuresThe primary outcome was time to death measured in days from immediate postoperative time up to the 28th day following surgery.ResultA total of 2530 surgical cases were followed for 67 145 person-days. There were 92 deaths, with an incidence rate of 1.37 (95% CI 1.11 to 1.68) deaths per 1000 person-day observations. Regional anaesthesia was significantly associated with lower postoperative mortality (adjusted hazard ratio (AHR) 0.18, 95% CI 0.05 to 0.62). Patients aged ≥65 years (AHR 3.04, 95% CI 1.65 to 5.75), American Society of Anesthesiologist (ASA) physical status III (AHR 2.41, 95% CI 1.1.13 to 5.16) and IV (AHR 2.74, 95% CI 1.08 to 6.92), emergency surgery (AHR 1.85, 95% CI 1.02 to 3.36) and preoperative oxygen saturation <95% (AHR 3.14, 95% CI 1.85 to 5.33) were significantly associated with a higher risk of postoperative mortality.ConclusionThe postoperative mortality rate at Tibebe Ghion Specialised Hospital was high. Age ≥65, ASA physical status III and IV, emergency surgery, and preoperative oxygen saturation <95% were significant predictors of postoperative mortality. Patients with the identified predictors should be offered targeted treatment.

Perioperative mortality rate and its predictors after emergency laparatomy at Debre Markos comprehensive specialized hospital, Northwest Ethiopia: 2023: retrospective follow-up study

“…In this study, the perioperative mortality rate was 25.5 per 1000 person-days [95% CI: (20.4, 30.9)] in 2978 person-days of observation. These findings are higher than expected relative to previous national estimation in Ethiopia(0.83%) [ 28 ] and previous perioperative mortality studies in Ethiopia [ 25 ] which might be explained by the severity of the illness. The findings from this study are also higher than findings from a multinational prospective study done by the Global surgery collaborative group (14.2%) [ 13 ] and a Denmark study (17%) [ 24 ].…”

“…Time bounded studies revealed an overall 30-day mortality of 17% [ 24 ]. A prospective study from Ethiopia revealed perioperative mortality incidence of 1.37 per 1000 person-day observations [ 25 ]. Another similar study to predict rates of mortality in the first 48 h postoperatively showed rates of 2.49% & 3.29% at 24 h and 48 h after surgery and anesthesia respectively with higher odds of mortality from emergency procedures [ 26 ].…”

Pre-Therapeutic Assessment of Older People in Sub-Saharan Africa: Introduction to the Comprehensive Geriatric Assessment

“…In Cote d’Ivoire, post-operative morbidity and mortality among older people undergoing emergency surgery for acute bowel obstructions were 32.2% and 16.9%, respectively [ 44 ]. In a follow-up study including 2530 participants, the hazard of postoperative mortality among older people was three-folds higher than among their younger counterparts in Ethiopia [ 45 ]. The reasons of this high mortality were not clearly reported, as pre-existing medical conditions were not investigated in the majority of these studies.…”

Pre-therapeutic Assessment of Older People in Sub-Saharan Africa: Introduction to the Comprehensive Geriatric Assessment

“…In Cote d'Ivoire, post-operative morbidity and mortality among older people undergoing emergency surgery for acute bowel obstructions were 32.2% and 16.9% respectively [41]. In a followup study including 2530 participants, the hazard of postoperative mortality among elderly was 3folds higher than among their younger counterparts in Ethiopia [42]. The reasons of this high mortality are not clearly reported as pre-existing medical conditions were not sought in the majority of these studies.…”