Nigerian surgical outcomes – Report of a 7-day prospective cohort study and external validation of the African surgical outcomes study surgical risk calculator

Osinaike, Babatunde; Ayandipo, Omobolaji; Onyeka, Tonia C.; Alagbe-Briggs, Olubusola; Mohammed, Alhassan Datti; Oyedepo, Olanrewaju Olubukola; Nuhu, Ahmed Mohammed; Asudo, Felicia; Akanmu, Olanrewaju; Nwokorie, Chris; Mohammed, Abdulrahman; Edubio, Mark; Izuora, Kodilinye; Mohammed, Rabiu; Nweze, Onochie; Efu, M E; Eguma, Stella; Jasper, Abiodun Oyinpreye; Ewah, Richard; Akhideno, Irene; Nnaji, Chimaobi Tim; Ado, Suleiman; Ogboli-Nwasor, Elizabeth; Atiku, Mamuda; Salisu, Ibrahim; Adinoyi, Yakubu; Agu, Edith; Desalu, I; Samuel, Luka; Yunus, Abdulghaffar Adeniyi; Fatungase, Oluwabunmi; Akinwonmi, Olugbenga; Faponle, Folayemi; Idowu, Olusola; Isamade, Erdoo S; Abdulrahman, Abdullahi; Buba, Shanka; Hamza, Garba; Onajin-Obembe, Bisola; Amanor-Boadu, S.D.; Investigators, Nigerian Surgical Outcomes Study

doi:10.1016/j.ijsu.2019.06.003

Cited by 20 publications

(13 citation statements)

References 31 publications

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“…The overall incidence of mortality in the SICU of three hospitals in Addis Ababa was found to be 44.97%. This result is consistent with the findings of studies done in Pakistan, Rwanda, Nigeria, Saint Paul Hospital Millennium Medical College, and Jimma University Specialized Hospital (16)(17)(18)(19)(20). However, it was higher than the previous study done in Tikur Anbessa Specialized Hospital (21).…”

Section: Discussionsupporting

confidence: 92%

Survival status and predictors of mortality among patients admitted to surgical intensive care units of Addis Ababa governmental hospitals, Ethiopia: A multicenter retrospective cohort study

Endeshaw

Fekede²,

Gesso³

et al. 2023

Front. Med.

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IntroductionCritical care is a serious global healthcare burden. Although a high number of surgical patients are being admitted to the surgical intensive care unit (SICU), the mortality remained high, particularly in low and middle-income countries. However, there is limited data in Ethiopia. Therefore, this study aimed to investigate the survival status and predictors of mortality in surgical patients admitted to the SICUs of Addis Ababa governmental hospitals, Ethiopia.MethodsA multicenter retrospective cohort study was conducted on 410 surgical patients admitted to the SICUs of three government hospitals in Addis Ababa selected using a simple random sampling from February 2017 to February 2020. The data were entered into Epidata version 4.6 and imported to STATA/MP version 16 for further analysis. Bi-variable and multivariable Cox regression models were fitted in the analysis to determine the predictor variables. A hazard ratio (HR) with a 95% confidence interval (CI) was computed, and variables with a p-value <0.05 were considered statistically significant.ResultsFrom a sample of 410 patients, 378 were included for final analysis and followed for a median follow-up of 5 days. The overall mortality among surgical patients in the SICU was 44.97% with an incidence rate of 5.9 cases per 100 person-day observation. Trauma (AHR = 1.83, 95% CI: 1.19–2.08), Glasgow coma score (GCS) <9 (AHR = 2.06, 95% CI: 1.28–3.31), readmission to the SICU (AHR = 3.52, 95% CI: 2.18–5.68), mechanical ventilation (AHR = 2.52, 95% CI: 1.23–5.15), and creatinine level (AHR = 1.09, 95% CI: 1.01–1.18) were found to be significantly associated with mortality in the SICU.ConclusionThe mortality of surgical patients in the SICU was high. Trauma, GCS <9 upon admission, readmission to the SICU, mechanical ventilation, and increased in the creatinine level on admission to the SICU were the identified predictors of mortality in the SICU.

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Section: Discussionsupporting

confidence: 92%

Survival status and predictors of mortality among patients admitted to surgical intensive care units of Addis Ababa governmental hospitals, Ethiopia: A multicenter retrospective cohort study

Endeshaw

Fekede²,

Gesso³

et al. 2023

Front. Med.

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“…Current published data have estimated that 313 million operations are performed annually, with most taking place in high-income and upper-middle income countries [1,4]. Unfortunately, only 6% of the 313 million procedures undertaken worldwide each year occur in the poorest countries where over a third of the world's population lives [1,[4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Surgical Capacity in Rural Southeast Nigeria: Barriers and New Opportunities

Ogbuanya¹,

Anyanwu²,

Ajah³

et al. 2021

Annals of Global Health

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Background: Remarkable gains have been made in global health with respect to provision of essential and emergency surgical and anesthesia care. At the same time, little has been written about the state of surgical care, or the potential strategies for scale-up of surgical services in sub-Saharan Africa, southeast Nigeria inclusive. Objective:The aim was to document the state of surgical care at district hospitals in southeast Nigeria. Methods:We surveyed 13 district hospitals using the World Health Organization (WHO) tool for situational analysis developed by the "Lancet Commission on Global Surgery" initiative to assess surgical care in rural Southeast Nigeria. A systematic literature review of scientific literatures and policy documents was performed. Extraction was performed for all articles relating to the five National Surgical, Obstetric and Anesthesia Plans (NSOAPs) domains: infrastructure, service delivery, workforce, information management and financing.Findings: Of the 13 facilities investigated, there were six private, four mission and three public hospitals. Though all the facilities were connected to the national power grid, all equally suffered electricity interruption ranging from 10-22 hours daily. Only 15.4% and 38.5% of the 13 hospitals had running water and blood bank services, respectively. Only two general surgeon and two orthopedic surgeons covered all the facilities. Though most of the general surgical procedures were performed in private and mission hospitals, the majority of the public hospitals had limited ability to do the same. Orthopedic procedures were practically non-existent in public hospitals. None of the facilities offered inhalational anesthetic technique. There was no designated record unit in 53.8% of facilities and 69.2% had no trained health record officer. Conclusion:Important deficits were observed in infrastructure, service delivery, workforce and information management. There were indirect indices of gross inadequacies in financing as well.

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“…When the tool was applied to preoperative assessment, it showed good discrimination and calibration to predict postoperative morbidity and mortality. The ASOS Risk Calculator was validated by a separate study that applied the tool to assess surgical outcomes in 1425 patients across 79 hospitals in Nigeria (Osinaike et al, 2019). While the new ASOS Risk Calculator is a promising advancement, roll-out to facilities in LMCIs would require a significant amount of retraining of surveyors and re-analysis of performance across broad patient samples in countries that use it.…”

Section: First Author Citationmentioning

confidence: 99%

Implementation of surgical site infection surveillance in low- and middle-income countries: A position statement for the International Society for Infectious Diseases

Mehtar¹,

Wanyoro²,

Ogunsola³

et al. 2020

International Journal of Infectious Diseases

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Surgical site infection (SSI) rates in low- and middle-income countries (LMICs) range from 8 to 30% of procedures, making them the most common healthcare acquired infection (HAI) with substantial morbidity, mortality, and economic impacts. Presented here is an approach to surgical site infection prevention based on surveillance and focused on five key areas as identified by international experts. These five areas include: Collecting valid, high-quality data; Linking HAIs to economic incapacity, underscoring the need to prioritize infection prevention activities; Implementing SSI surveillance within infection prevention and control (IPC) programs to enact structural changes, develop procedural skills, and alter healthcare worker behaviors; Priotiziation of IPC training for healthcare workers in LMICs to conduct broad-based surveillance coupled with the development and implementation of locally applicable IPC programs; Developing a highly accurate and objective international system for defining SSIs that can be translated globally in a straightforward manner. Finally, we present a clear, unambiguous framework for successful SSI guideline implementation that supports the development of sustainable IPC programs in LMICs. This entails: i) identifying index operations for targeted surveillance; ii) identifying IPC “champions” and empowering healthcare workers; iii) using multimodal improvement measures; iv) positioning hand hygiene programs as the basis for IPC initiatives; and v), use of telecommunication devices for surveillance and healthcare outcome follow-ups. Additionally, special considerations for pediatric SSIs, antimicrobial resistance development, and antibiotic stewardship programs are addressed.

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Nigerian surgical outcomes – Report of a 7-day prospective cohort study and external validation of the African surgical outcomes study surgical risk calculator

Cited by 20 publications

References 31 publications

Survival status and predictors of mortality among patients admitted to surgical intensive care units of Addis Ababa governmental hospitals, Ethiopia: A multicenter retrospective cohort study

Survival status and predictors of mortality among patients admitted to surgical intensive care units of Addis Ababa governmental hospitals, Ethiopia: A multicenter retrospective cohort study

Surgical Capacity in Rural Southeast Nigeria: Barriers and New Opportunities

Implementation of surgical site infection surveillance in low- and middle-income countries: A position statement for the International Society for Infectious Diseases

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