Perioperative mortality: Analysis of 3 years of operative data across 7 general surgical projects of Médecins Sans Frontières in Democratic Republic of Congo, Central African Republic, and South Sudan

Abstract

POMRs varied by age group and type of major procedure performed. Collecting surgical data is achievable and can inform future planning and support for national surgical programs. More information is needed on operative outcomes in adults and children in low-resource settings to improve quality and access to care.

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

“…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. 14 Our observations are also consistent with reports of intraoperative and/or anaesthetic related mortality rates in low-income countries.…”

South African Paediatric Surgical Outcomes Study: a 14-day prospective, observational cohort study of paediatric surgical patients

“…This study supports previous studies that highlight the impact of emergency surgery and infection on paediatric surgical morbidity in Africa. 14,28,29 In addition, it demonstrates that infection as an indication for surgery is an important predictor of risk. Paediatric surgical mortality in LMICs has been reported to be from two to 10 times that of HICs, 14,25,26 and 100-fold higher for certain LICs.…”

Mortality following surgery for trauma in an Indian trauma cohort

“…The 30‐day mortality rate for the entire TITCO cohort (surgery or no surgery) is 21·4 per cent, slightly lower than the 30‐day perioperative mortality rate of 23·1 per cent reported here. This perioperative mortality rate is high compared with rates for emergency surgery from several studies in other low‐resource settings (hospitals in the Democratic Republic of Congo, Central African Republic, South Sudan, Papua New Guinea and South Africa). Notably, the 30‐day perioperative mortality rate is much higher than the rate at 48 h. Other studies have shown that most trauma deaths occur within 48 h of admission, both in low‐ and high‐income settings.…”

“…This perioperative mortality rate is high compared with rates for emergency surgery from several studies in other low‐resource settings (hospitals in the Democratic Republic of Congo, Central African Republic, South Sudan, Papua New Guinea and South Africa). Notably, the 30‐day perioperative mortality rate is much higher than the rate at 48 h. Other studies have shown that most trauma deaths occur within 48 h of admission, both in low‐ and high‐income settings. This is not the case here, where 74·2 per cent of deaths were outside of the first 48 h after surgery, an unexpected finding considering that the data in this study related solely to trauma surgery.…”

“…Perioperative mortality is a combined metric as it is measured at two time points: the day of surgery and at 30 days or time of discharge from hospital. Perioperative mortality rate is commonly defined as the proportion of in‐hospital deaths to the number of procedures or surgical admissions.…”