Monitoring Anesthesia Care Delivery and Perioperative Mortality in Kenya Utilizing a Provider-driven Novel Data Collection Tool

Sileshi, Bantayehu; Newton, Mark; Kiptanui, J.; Shotwell, Matthew S.; Wanderer, Jonathan P.; Mungai, Mary; Scherdin, Jon; Harris, Paul A.; Vermund, Sten H.; Sandberg, Warren S.; McEvoy, Matthew D.

doi:10.1097/aln.0000000000001713

Cited by 34 publications

(40 citation statements)

References 29 publications

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“…The great majority of these deaths occur on the days following surgery, and it seems likely that many are preventable. There are few published reports of postoperative outcomes in Africa, but our interpretation is consistent with the findings of a number of smaller epidemiological studies exploring postoperative mortality in African countries, with described mortality rates which were similar to, 14,28 or higher than those in the current study. 29,30 In a recent global study of mortality following emergency abdominal surgery, the majority of deaths also occurred more than 24 hours surgery.…”

Section: Discussionsupporting

confidence: 92%

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

Biccard¹,

Madiba²,

Kluyts³

et al. 2018

The Lancet

420

426

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Section: Discussionsupporting

confidence: 92%

“…Recent work has demonstrated the feasibility of surgical outcomes audit in low-income countries. 28,34 A pragmatic continent-wide quality improvement programme may improve the allocation of resources towards the postoperative surveillance of patients most at risk. A simple surgical risk calculator may facilitate this approach.…”

Section: Discussionmentioning

confidence: 99%

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

Biccard¹,

Madiba²,

Kluyts³

et al. 2018

The Lancet

420

426

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“…We have previously described the creation and implementation of a laptop-based electronic data collection system in Kenya at a large nongovernmental hospital. 12 In that study, we noted that the prospectively collected perioperative mortality rate among all surgical patients was lower than estimates based on retrospective reviews. After this feasibility demonstration, we scaled our data collection capacity to include all levels (primary, secondary, tertiary) of government and nongovernment hospitals (24) in Kenya over a 3-yr period focusing on the pediatric surgical patient.…”

Section: What This Article Tells Us That Is Newmentioning

confidence: 90%

“…Two-year data from Kijabe Hospital were previously published by our group. 12 Questionnaire A total of 132 data elements were collected on each surgical case, with selection of data fields guided by two main principles. The first principle was to include all data fields that have been reported as clinically significant to understanding baseline characteristics of surgical care and outcomes in low-and middle-income countries.…”

Section: Methodsmentioning

confidence: 99%

“…Previous research has shown that data collection requires extensive training and reinforcement to capture the cases in a prospective, accurate fashion. 12 We have demonstrated the feasibility of prospective electronic data collection of the pediatric perioperative mortality rate at scale in Kenya. The data collection tool was able to be used in the operating room by both physician and nonphysician anesthesia providers in multiple regions (urban, rural) across the country.…”

Section: Prospective Electronic Pediatric Perioperative Mortality Ramentioning

confidence: 99%

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Pediatric Perioperative Mortality in Kenya

et al. 2020

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Background The global surgery access imbalance will have a dramatic impact on the growing population of the world’s children. In regions of the world with pediatric surgery and anesthesia manpower deficits and pediatric surgery–specific infrastructure and supply chain gaps, this expanding population will present new challenges. Perioperative mortality rate is an established indicator of the quality and safety of surgical care. To establish a baseline pediatric perioperative mortality rate and factors associated with mortality in Kenya, the authors designed a prospective cohort study and measured 24-h, 48-h, and 7-day perioperative mortality. Methods The authors trained anesthesia providers to electronically collect 132 data elements for pediatric surgical cases in 24 government and nongovernment facilities at primary, secondary, and tertiary hospitals from January 2014 to December 2016. Data assistants tracked all patients to 7 days postoperative, even if they had been discharged. Adjusted analyses were performed to compare mortality among different hospital levels after adjusting for prespecified risk factors. Results Of 6,005 cases analyzed, there were 46 (0.8%) 24-h, 62 (1.1%) 48-h, and 77 (1.7%) 7-day cumulative mortalities reported. In the adjusted analysis, factors associated with a statistically significant increase in 7-day mortality were American Society of Anesthesiologists Physical Status of III or more, night or weekend surgery, and not having the Safe Surgery Checklist performed. The 7-day perioperative mortality rate is less in the secondary (1.4%) and tertiary (2.4%) hospitals when compared with the primary (3.7%) hospitals. Conclusions The authors have established a baseline pediatric perioperative mortality rate that is greater than 100 times higher than in high-income countries. The authors have identified factors associated with an increased mortality, such as not using the Safe Surgery Checklist. This analysis may be helpful in establishing pediatric surgical care systems in low–middle income countries and develop research pathways addressing interventions that will assist in decreasing mortality rate. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Unifying Children’s Surgery and Anesthesia Stakeholders Across Institutions and Clinical Disciplines: Challenges and Solutions from Uganda

et al. 2019

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Background There is a significant unmet need for children's surgical care in low-and middle-income countries (LMICs). Multidisciplinary collaboration is required to advance the surgical and anesthesia care of children's surgical conditions such as congenital conditions, cancer and injuries. Nonetheless, there are limited examples of this process from LMICs. We describe the development and 3-year outcomes following a 2015 stakeholders' meeting in Uganda to catalyze multidisciplinary and multi-institutional collaboration. Methods The stakeholders' meeting was a daylong conference held in Kampala with local, regional and international collaborators in attendance. Multiple clinical specialties including surgical subspecialists, pediatric anesthesia, perioperative nursing, pediatric oncology and neonatology were represented. Key thematic areas including infrastructure, training and workforce retention, service delivery, and research and advocacy were addressed, and shortterm objectives were agreed upon. We reported the 3-year outcomes following the meeting by thematic area. Results The Pediatric Surgical Foundation was developed following the meeting to formalize coordination between institutions. Through international collaborations, operating room capacity has increased. A pediatric general surgery fellowship has expanded at Mulago and Mbarara hospitals supplemented by an international fellowship in multiple disciplines. Coordinated outreach camps have continued to assist with training and service delivery in rural regional hospitals. Conclusion Collaborations between disciplines, both within LMICs and with international partners, are required to advance children's surgery. The unification of stakeholders across clinical disciplines and institutional partnerships can facilitate increased children's surgical capacity. Such a process may prove useful in other LMICs with a wide range of children's surgery stakeholders.

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Monitoring Anesthesia Care Delivery and Perioperative Mortality in Kenya Utilizing a Provider-driven Novel Data Collection Tool

Cited by 34 publications

References 29 publications

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

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

Pediatric Perioperative Mortality in Kenya

Unifying Children’s Surgery and Anesthesia Stakeholders Across Institutions and Clinical Disciplines: Challenges and Solutions from Uganda

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