Postoperative Outcomes Associated with Surgical Care for Women in Africa: an International Risk-adjusted Analysis of Prospective Observational Cohorts

Overview

Journal BJA Open

Specialty Anesthesiology

Date 2023 Aug 17

PMID 37588786

Authors

Amy Paterson

Salome Maswime

Anneli Hardy

Rupert M Pearse

Bruce M Biccard

Affiliations

Soon will be listed here.

Abstract

Background: Improving women's health is a critical component of the sustainable development goals. Although obstetric outcomes in Africa have received significant focus, non-obstetric surgical outcomes for women in Africa remain under-examined.

Methods: We did a secondary analysis of the African Surgical Outcomes Study (ASOS) and International Surgical Outcomes Study (ISOS), two 7-day prospective observational cohort studies of outcomes after adult inpatient surgery. This sub-study focuses specifically on the analysis of the female, elective, non-obstetric, non-gynaecological surgical data collected during these two large multicentre studies. The African data from both cohorts are compared with international (non-African) outcomes in a risk-adjusted logistic regression analysis using a generalised linear mixed-effects model. The primary outcome was severe postoperative complications including in-hospital mortality in Africa compared with non-African outcomes.

Results: A total of 1698 African participants and 18 449 international participants met the inclusion criteria. The African cohort were younger than the international cohort with a lower preoperative risk profile. Severe complications occurred in 48 (2.9%) of 1671, and 431 (2.3%) of 18 449 patients in the African and international cohorts, respectively, with in-hospital mortality after severe complications of 23/48 (47.9%) in Africa and 78/431 (18.1%) internationally. Women in Africa had an adjusted odds ratio of 2.06 (95% confidence interval, 1.17-3.62; =0.012) of developing a severe postoperative complication after elective non-obstetric, non-gynaecological surgery, compared with the international cohort.

Conclusions: Women in Africa have double the risk adjusted odds of severe postoperative complications (including in-hospital mortality) after elective non-obstetric, non-gynaecological surgery compared with the international incidence.

Citing Articles

Postoperative mortality in Africa: are there any improvements in the last decade?.

Awuah W, Ng J, Nazir A, Tenkorang P, Yarlagadda R, Kalmanovich J Int J Surg. 2023; 109(5):1080-1082.

PMID: 36927691 PMC: 10389384. DOI: 10.1097/JS9.0000000000000125.

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