Postoperative outcomes associated with surgical care for women in Africa: an international risk-adjusted analysis of prospective observational cohorts

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Postoperative outcomes associated with surgical care for women in Africa: an international risk-adjusted analysis of prospective observational cohorts


JournalBJA Open
Article typeJournal research article – Clinical research
Publication date – Oct – 2022
Authors – Amy Paterson, Salome Maswime, Anneli Hardy, Rupert M. Pearse, Bruce M. Biccard, in collaboration with the African Surgical Outcomes (ASOS) group and International Surgical Outcomes (ISOS) group
KeywordsAfrican surgical outcomes, global women’s health, international surgical outcomes, Perioperative care, postoperative outcomes, risk-adjusted analysis, women in Africa
Open access – Yes
SpecialityGeneral surgery
World region Central Africa, Eastern Africa, Middle Africa, Northern Africa, Southern Africa, Western Africa

Language – English
Submitted to the One Surgery Index on November 5, 2022 at 10:21 pm
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; P=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.

OSI Number – 21814

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