Perioperative Management of Gastrointestinal Surgery in a Resource-limited Hospital in Niger: Cross-sectional Study

Overview

Journal Ann Med Surg (Lond)

Publisher Wolters Kluwer

Specialty Medical Education

Date 2020 Apr 24

PMID 32322389

Authors

Harissou Adamou

Ibrahim Amadou Magagi

Ousseini Adakal

Mahamadou Doutchi

Oumarou Habou

Mamane Boukari

Lassey James Didier

Rachid Sani

Affiliations

Soon will be listed here.

Abstract

Background: Perioperative management in digestive surgery is a challenge in sub-Saharan Africa. Objective: To describe the process and outcomes of perioperative management in gastrointestinal surgery.

Materials And Methods: This was a single center cross-sectional study over a 4-month period from June 1 to September 30, 2017, in a Nigerien hospital (West Africa). This study included caregivers and patients operated on gastrointestinal surgery.

Results: We collected data for 56 caregivers and 253 patients underwent gastrointestinal surgery. The average age of caregivers was 38.6 ± 8.7. The median length of professional practice was 9 years. Almost 52% of caregivers (n = 29) did not know the standards of perioperative care. The median age of patients was 24 years, and male gender constituted 70% of cases (n = 177) with a sex ratio of 2.32. Patients came from rural areas in 78.2% (n = 198). Emergency surgery accounted for 60% (n = 152). The most surgical procedure was digestive ostomies performed in 28.9% (n = 73), followed by hernia repair and appendectomy in 24.5% (n = 62) and 13.9% (n = 35) respectively. The postoperative course was complicated in 28.1% (n = 71) among which 13 deaths. In the group of caregivers, the poor practice of perioperative management was associated with poor professional qualification, insufficient equipment, insufficient motivation (p < 0.05). The ASA3&ASA4 score, undernutrition, emergency surgery, poor postoperative monitoring, and poor psychological preparation were associated with complicated postoperative outcomes (p < 0.05).

Conclusion: The inadequacy of the technical platform and the lack of continuous training for healthcare staff represented the main dysfunctions of our hospital. The risk factors for complications found in this study need appropriate perioperative management to improve prognosis in gastrointestinal surgery.

References

Mariette C, Alves A, Benoist S, Bretagnol F, Mabrut J, Slim K . [Perioperative care in digestive surgery]. J Chir (Paris). 2005; 142(1):14-28. DOI: 10.1016/s0021-7697(05)80831-2. View

Gustafsson U, Scott M, Hubner M, Nygren J, Demartines N, Francis N . Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: 2018. World J Surg. 2018; 43(3):659-695. DOI: 10.1007/s00268-018-4844-y. View

Kluyts H, Le Manach Y, Munlemvo D, Madzimbamuto F, Basenero A, Coulibaly Y . The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications. Br J Anaesth. 2018; 121(6):1357-1363. DOI: 10.1016/j.bja.2018.08.005. View

Clavien P, Sanabria J, Strasberg S . Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992; 111(5):518-26. View

Jammer I, Wickboldt N, Sander M, Smith A, Schultz M, Pelosi P . Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome.... Eur J Anaesthesiol. 2014; 32(2):88-105. DOI: 10.1097/EJA.0000000000000118. View

Magagi I, Adamou H, Habou O, Magagi A, Halidou M, Ganiou K . [Digestive surgical emergencies in Sub-Saharan Africa: a prospective study of a series of 622 patients at the National Hospital of Zinder, Niger]. Bull Soc Pathol Exot. 2016; 110(3):191-197. DOI: 10.1007/s13149-016-0499-9. View

Selvy M, Le Roy B, Abjean A, Veziant J, Pereira B, Slim K . The increasing prominence of "non-surgical" articles in surgical literature. J Visc Surg. 2019; 157(1):37-41. DOI: 10.1016/j.jviscsurg.2019.06.012. View

Gordon T, BOWMAN H, Bass E, Lillemoe K, Yeo C, Heitmiller R . Complex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes. J Am Coll Surg. 1999; 189(1):46-56. DOI: 10.1016/s1072-7515(99)00072-1. View

Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G . STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int J Surg. 2019; 72:156-165. DOI: 10.1016/j.ijsu.2019.11.002. View

10.

Meara J, Leather A, Hagander L, Alkire B, Alonso N, Ameh E . Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015; 386(9993):569-624. DOI: 10.1016/S0140-6736(15)60160-X. View

11.

Biccard B, Rodseth R, Cronje L, Agaba P, Chikumba E, Du Toit L . A meta-analysis of the efficacy of preoperative surgical safety checklists to improve perioperative outcomes. S Afr Med J. 2016; 106(6). DOI: 10.7196/SAMJ.2016.v106i6.9863. View

12.

Weiser T, Haynes A, Molina G, Lipsitz S, Esquivel M, Uribe-Leitz T . Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet. 2015; 385 Suppl 2:S11. DOI: 10.1016/S0140-6736(15)60806-6. View

13.

Higashi H, Barendregt J, Kassebaum N, Weiser T, Bickler S, Vos T . Surgically avertable burden of digestive diseases at first-level hospitals in low and middle-income regions. Surgery. 2014; 157(3):411-9. DOI: 10.1016/j.surg.2014.07.009. View

14.

Rickard J, Ntakiyiruta G, Chu K . Associations with Perioperative Mortality Rate at a Major Referral Hospital in Rwanda. World J Surg. 2015; 40(4):784-90. DOI: 10.1007/s00268-015-3308-x. View

15.

Vester-Andersen M, Lundstrom L, Moller M, Waldau T, Rosenberg J, Moller A . Mortality and postoperative care pathways after emergency gastrointestinal surgery in 2904 patients: a population-based cohort study. Br J Anaesth. 2014; 112(5):860-70. DOI: 10.1093/bja/aet487. View

16.

Biccard B, Madiba T, Kluyts H, Munlemvo D, Madzimbamuto F, Basenero A . Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet. 2018; 391(10130):1589-1598. DOI: 10.1016/S0140-6736(18)30001-1. View

17.

Adamou H, Habou O, Amadou-Magagi I, Doutchi M, Amadou M, Halidou M . Non-traumatic acute peritonitis in children: causes and prognosis in 226 patients at the National Hospital of Zinder, Niger. Med Sante Trop. 2017; 27(3):264-269. DOI: 10.1684/mst.2017.0692. View

18.

Kynes J, Walters C, Pinto E, Jeque E, McQueen K . A profile of surgical burden and anaesthesia services at Mozambique's Central Hospital: A review. Int J Surg. 2018; 54(Pt A):285-289. DOI: 10.1016/j.ijsu.2018.04.055. View

19.

Mambou Tebou C, Temgoua M, Esiene A, Nana B, Noubiap J, Sobngwi E . Impact of perioperative nutritional status on the outcome of abdominal surgery in a sub-Saharan Africa setting. BMC Res Notes. 2017; 10(1):484. PMC: 5604173. DOI: 10.1186/s13104-017-2765-8. View

20.

Diant L, Sordes F, Chaubard T . [Psychological impact of ostomy on the quality of life of colorectal cancer patients: Role of body image, self-esteem and anxiety]. Bull Cancer. 2018; 105(6):573-580. DOI: 10.1016/j.bulcan.2018.03.005. View