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

Bruce M. Biccard, Thandinkosi E. Madiba, Hyla Louise Kluyts, Dolly M. Munlemvo, Farai D. Madzimbamuto, Apollo Basenero, Christina Salmina Gordon, Coulibaly Youssouf, Sylvia R. Rakotoarison, Veekash Gobin, Ahmadou L. Samateh, Chaibou M. Sani, Akinyinka O. Omigbodun, Simbo D. Amanor-Boadu, Janat T. Tumukunde, Tonya M. Esterhuizen, Yannick Le Manach, Patrice Forget, Abdulaziz M. Elkhogia, R. M. MehyaouiEugene Zoumeno, Gabriel Ndayisaba, Henry Ndasi, Andrew K.N. Ndonga, Zipporah W.W. Ngumi, Ushmah P. Patel, Daniel Zemenfes Ashebir, Akwasi A.K. Antwi-Kusi, Bernard Mbwele, Hamza Doles Sama, Mahmoud Elfiky, Maher A. Fawzy, Rupert M. Pearse, Hippolyte Abadagan, N. Abbas, A. Ibrahim Abdelatif, Traoré Abdoulaye, A. Abd-rouf, A. Abduljalil, A. Abdulrahman, S. Abdurazig, A. Abokris, W. Abozaid, S. O.A. Abugassa, F. Abuhdema, S. A. Abujanah, R. Abusamra, A. Abushnaf, S. A. Abusnina, T. S. Abuzalout, H. M. Ackermann, Y. B. Adamu, A. Addanfour, D. M. Adeleke, T. A. Adigun, A. O. Adisa, Sèhivè Valéry Adjignon, N. A. Adu-Aryee, B. B. Afolabi, A. F.X. Agaba, P. K.A. Agaba, K. Aghadi, H. Agilla, B. Ahmed, El Z. Ahmed, Al J. Ahmed, M. Ahmed, Rene Ahossi, S. A. Aji, S. Akanyun, I. Akhideno, M. Akhter, O. A. Akinyemi, M. Akkari, Joseph Akodjenou, A. L. AL Samateh, E. S. al Shams, O. T. Alagbe-Briggs, E. A. Alakkari, R. B. Alalem, M. Alashhab, O. I. Alatise, A. Alatresh, M. S.I. Alayeb Alayeb, B. A. Albakosh, F. Albert, A. N.J.D. Alberts, A. D. Aldarrat, A. Alfari, A. Alfetore, M. Algbali, A. Algddar, H. A. Algedar, I. A. Alghafoud, A. Alghazali, M. Alhajj, A. Alhendery Alhendery, F. F.H. Alhoty, A. Ali, Y. A. Ali, Beye Seïdina Alioune, M. A. Alkassem, M. A. Alkchr, T. S. Alkesa, A. Alkilani, F. Alkobty Alkobty, Thomas Allaye, S. B.M. Alleesaib, A. Alli, K. Allopi, N. L. Allorto, A. Almajbery, R. Almesmary, S. H.A. Almisslati, F. Almoraid, H. Alobeidi, M. A. Alomami, Christella S. Alphonsus, O. A. Alqawi, A. A. Alraheem, S. A. Alsabri, A. Alsayed, B. Alsellabi, M. Al-Serksi, M. S.A. Alshareef, A. A. Altagazi, J. S. Aluvale, H. W. Alwahedi, E. A. Alzahra, M. A. Alzarouk, K. Al-Zubaidy, Maiga Amadou, Al A. Amer, B. T. Amisi, M. A. Amuthenu, T. W.A. Anabah, Felix Anani, P. G.R. Anderson, A. G.B. Andriamampionona, L. Andrianina, A. Anele, R. Angelin, N. Anjar, O. Antùnez, Akwasi Antwi-Kusi, L. J.C. Anyanwu, A. A. Aribi, O. A. Arowolo, O. Arrey, S. B. Assefa, Guy Assoum, V. Athanse, J. S. Athombo, M. Atiku, E. Atito-Narh, Anatole Atomabe, A. Attia, M. Aungraheeta, D. M.A. Aurélia, O. O. Ayandipo, A. E.T. Ayebale, H. M.Z. Azzaidey, N. B. Babajee, H. B. Badi, E. K. Badianga, R. B. Baghni, M. T. Bahta, M. Bai, Y. Baitchu, A. M. Baloyi, K. A. Bamuza, M. I. Bamuza, L. Bangure, O. B. Bankole, M. L. Barongo, M. M. Barow, L. Bashiya, C. H. Basson, Sudha Bechan, S. Belhaj, M. M. Ben Mansour, D. Benali, A. S.B. Benamour, A. Berhe, J. D. Bertie, J. J.A. Bester, M. Bester, J. D. Bezuidenhout, K. Bhagwan, D. R. Bhagwandass, K. A.P. Bhat, M. M.Z.U. Bhuiyan, F. Bigirimana, C. J. Bikuelo, B. E. Bilby, S. S. Bingidimi, K. E. Bischof, David G. Bishop, C. Bitta, M. Bittaye, Thuli Biyase, C. A. Blake, E. Blignaut, F. Blignaut, B. N. BN Tanjong, A. Bogoslovskiy, P. M. Boloko, S. K.B. Boodhun, I. Bori, F. Boufas, M. Brand, Nicholas T. Brouckaert, J. D. Bruwer, I. Buccimazza, I. M. Bula Bula, Fred Bulamba, B. C. Businge, Y. B. Bwambale, S. R.C. Cacala, M. A. Cadersa, Chris Cairns, F. Carlos, M. E. Casey, A. C. Castro, N. D. Chabayanzara, M. S. Chaibou, T. N.O. Chaibva, N. K. Chakafa, C. Chalo, C. Changfoot, M. C. Chari, L. Chelbi, J. T. Chibanda, H. N. Chifamba, N. Chikh, E. Chikumba, P. Chimberengwa, J. Chirengwa, F. M. Chitungo, M. C. Chiwanga, M. M. Chokoe, T. M. Chokwe, B. Chrirangi, M. Christian, B. Church, J. C. Cisekedi, J. N. Clegg-Lamptey, Estie Cloete, Megan Coltman, W. Conradie, N. Constance, Youssouf Coulibaly, L. Cronje, M. A. Da Silva, H. Daddy, L. Dahim, D. Daliri, M. S. Dambaki, A. Dasrath, J. G. Davids, Gareth L. Davies, J. T. De Lange, J. B. de Wet, B. Dedekind, M. A. Degaulle, V. Dehal, P. D. Deka, S. Delinikaytis, I. S. Desalu, Hubert Dewanou, MB Moussa Deye, C. Dhege, B. S.G. Diale, D. F. Dibwe, B. J.S. Diedericks, J. M. Dippenaar, L. Dippenaar, M. P. Diyoyo, Edith Djessouho, S. N. Dlamini, A. Dodiyi-Manuel, B. A. Dokolwana, D. P. Domoyyeri, Leanne W. Drummond, D. E. du Plessis, W. M. du Plessis, L. J. du Preez, K. Dube, N. Z. Dube, K. D. Dullab, R. Duvenhage, R. C. Echem, S. A. Edaigbini, A. K. Egote, A. Ehouni, G. Ekwen, N. C. Ekwunife, M. El Hensheri, I. E. Elfaghi, M. A. Elfagieh, S. Elfallah, S. Elgelany, A. M. Elghallal, M. G. Elghandouri, Z. S. Elghazal, A. M. Elghobashy, F. T. Elharati, R. M. Elkhwildi, S. Ellis, L. Elmadani, H. B. Elmadany, H. Elmehdawi, A. Elmgadmi, H. Eloi, D. Elrafifi, G. Elsaadi, R. B. Elsaity, A. Elshikhy, M. Eltaguri, A. Elwerfelli, I. E. Elyasir, A. Z. Elzoway, A. M. Elzufri, E. O. Enendu, B. C. Enicker, E. O. Enwerem, R. Esayas, M. Eshtiwi, A. A. Eshwehdi, J. L. Esterhuizen, E. B. Etuk, O. Eurayet, O. R. Eyelade, R. F. Fanjandrainy, Lionelle Fanou, Z. Farina, Maher Fawzy, A. Feituri, N. L. Fernandes, L. M. Ford, T. François, T. Freeman, Y. B.M. Freeman, V. M. Gacii, B. Gadi, M. Gagara, A. Gakenia, P. D. Gallou, G. G.N. Gama, M. G. Gamal, Y. G. Gandy, A. Ganesh, Diallo Gangaly, M. Garcia, A. P. Gatheru, S. S.D. Gaya, Oswald Gbéhadé, G. Gerbel, A. Ghnain, R. Gigabhoy, D. G. Giles, G. T. Girmaye, S. Gitau, B. Githae, Said Gitta, Riaz Goga, A. A.G. Gomati, M. E. Gonzalez, J. Gopall, O. Gorelyk, M. Gova, K. Govender, P. Govender, S. Govender, V. Govindasamy, J. T.K. Green-Harris, M. B. Greenwood, S. V. Grey-Johnson, Mariette Grobbelaar, M. A. Groenewald, K. K. Grünewald, Ambroise Guegni, M. Guenane, S. Gueye, Marius Guezo, T. Gunguwo, M. G. Gweder, M. Gwila, L. Habimana, Rodrigue Hadecon, E. Hadia, L. Hamadi, M. Hammouda, M. I. Hampton, R. Hanta, Tim C. Hardcastle, J. A. Hariniaina, S. Hariparsad, A. H. Harissou, R. Harrichandparsad, S. H.A. Hasan, H. B. Hashmi, M. P. Hayes, A. Hdud, S. H. Hebli, H. M.S.N. Heerah, S. Hersi, A. H. Hery, Adam Hewitt-Smith, T. C. Hlako, S. C.H. Hodges, Richard Eric Hodgson, M. Hokoma, H. Holder, E. B. Holford, E. Horugavye, C. Houston, M. Hove, D. Hugo, C. M. Human, H. Hurri, O. Huwidi, A. I. Ibrahim, Traoré Ibrahim, O. K. Idowu, I. E. Igaga, John Igenge, O. Ihezie, K. Ikandi, I. A.R. Ike, J. J.N. Ikuku, M. N. Ilbarasi, I. B.B. Ilunga, J. P.M. Ilunga, N. A.V. Imbangu, Z. Imessaoudene, D. H. Imposo, A. M. Iraya, M. Isaacs, M. Isiguzo, A. Issoufou, P. Izquirdo, A. Jaber, U. V. Jaganath, C. S. Jallow, S. Jamabo, Z. S. Jamal, L. Janneh, M. J. Jannetjies, I. Jasim, Megan AJ Jaworska, S. Jay Narain, K. Jermi, R. Jimoh, S. Jithoo, M. Johnson, S. Joomye, R. M. Judicael, M. Judicaël, A. Juwid, L. P. Jwambi, R. Kabango, J. K. Kabangu, D. K. Kabatoro, A. N. Kabongo, K. Kabongo, L. T. Kabongo, M. D. Kabongo, N. Kady, S. Kafu, M. Kaggya, B. N.K. Kaholongo, P. C.K. Kairuki, S. I. Kakololo, K. Kakudji, Amina Kalisa, R. Kalisa, M. R. Kalufwelu, S. Kalume, R. J. Kamanda, M. K. Kangili, H. Kanoun

Research output: Contribution to journalArticle

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Abstract

Background: There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. Methods: We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899). Findings: We recruited 11 422 patients (median 29 [IQR 10–70]) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000–2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2–1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65–578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years [SD 16·1]), with a lower risk profile (American Society of Anesthesiologists median score 1 [IQR 1–2]) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18·2%, 95% CI 17·4–18·9]) of 10 885 patients. 239 (2·1%) of 11 193 patients died, 225 (94·1%) after the day of surgery. Infection was the most common complication (1156 [10·2%] of 10 970 patients), of whom 112 (9·7%) died. Interpretation: Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective. Funding: Medical Research Council of South Africa.
Original languageEnglish
Pages (from-to)1589-1598
Number of pages10
JournalThe Lancet
Volume391
Issue number10130
Early online date3 Jan 2018
DOIs
Publication statusPublished - 21 Apr 2018

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Observational Studies
Cohort Studies
Outcome Assessment (Health Care)
Population
South Africa
Ambulatory Surgical Procedures
Biomedical Research
Inpatients
HIV
Databases
Delivery of Health Care
Health
Therapeutics
Infection

Cite this

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

Perioperative patient outcomes in the African Surgical Outcomes Study : a 7-day prospective observational cohort study. / Biccard, Bruce M.; Madiba, Thandinkosi E.; Kluyts, Hyla Louise; Munlemvo, Dolly M.; Madzimbamuto, Farai D.; Basenero, Apollo; Gordon, Christina Salmina; Youssouf, Coulibaly; Rakotoarison, Sylvia R.; Gobin, Veekash; Samateh, Ahmadou L.; Sani, Chaibou M.; Omigbodun, Akinyinka O.; Amanor-Boadu, Simbo D.; Tumukunde, Janat T.; Esterhuizen, Tonya M.; Manach, Yannick Le; Forget, Patrice; Elkhogia, Abdulaziz M.; Mehyaoui, R. M.; Zoumeno, Eugene; Ndayisaba, Gabriel; Ndasi, Henry; Ndonga, Andrew K.N.; Ngumi, Zipporah W.W.; Patel, Ushmah P.; Ashebir, Daniel Zemenfes; Antwi-Kusi, Akwasi A.K.; Mbwele, Bernard; Sama, Hamza Doles; Elfiky, Mahmoud; Fawzy, Maher A.; Pearse, Rupert M.; Abadagan, Hippolyte; Abbas, N.; Abdelatif, A. Ibrahim; Abdoulaye, Traoré; Abd-rouf, A.; Abduljalil, A.; Abdulrahman, A.; Abdurazig, S.; Abokris, A.; Abozaid, W.; Abugassa, S. O.A.; Abuhdema, F.; Abujanah, S. A.; Abusamra, R.; Abushnaf, A.; Abusnina, S. A.; Abuzalout, T. S.; Ackermann, H. M.; Adamu, Y. B.; Addanfour, A.; Adeleke, D. M.; Adigun, T. A.; Adisa, A. O.; Adjignon, Sèhivè Valéry; Adu-Aryee, N. A.; Afolabi, B. B.; Agaba, A. F.X.; Agaba, P. K.A.; Aghadi, K.; Agilla, H.; Ahmed, B.; Ahmed, El Z.; Ahmed, Al J.; Ahmed, M.; Ahossi, Rene; Aji, S. A.; Akanyun, S.; Akhideno, I.; Akhter, M.; Akinyemi, O. A.; Akkari, M.; Akodjenou, Joseph; AL Samateh, A. L.; al Shams, E. S.; Alagbe-Briggs, O. T.; Alakkari, E. A.; Alalem, R. B.; Alashhab, M.; Alatise, O. I.; Alatresh, A.; Alayeb Alayeb, M. S.I.; Albakosh, B. A.; Albert, F.; Alberts, A. N.J.D.; Aldarrat, A. D.; Alfari, A.; Alfetore, A.; Algbali, M.; Algddar, A.; Algedar, H. A.; Alghafoud, I. A.; Alghazali, A.; Alhajj, M.; Alhendery Alhendery, A.; Alhoty, F. F.H.; Ali, A.; Ali, Y. A.; Alioune, Beye Seïdina; Alkassem, M. A.; Alkchr, M. A.; Alkesa, T. S.; Alkilani, A.; Alkobty Alkobty, F.; Allaye, Thomas; Alleesaib, S. B.M.; Alli, A.; Allopi, K.; Allorto, N. L.; Almajbery, A.; Almesmary, R.; Almisslati, S. H.A.; Almoraid, F.; Alobeidi, H.; Alomami, M. A.; Alphonsus, Christella S.; Alqawi, O. A.; Alraheem, A. A.; Alsabri, S. A.; Alsayed, A.; Alsellabi, B.; Al-Serksi, M.; Alshareef, M. S.A.; Altagazi, A. A.; Aluvale, J. S.; Alwahedi, H. W.; Alzahra, E. A.; Alzarouk, M. A.; Al-Zubaidy, K.; Amadou, Maiga; Amer, Al A.; Amisi, B. T.; Amuthenu, M. A.; Anabah, T. W.A.; Anani, Felix; Anderson, P. G.R.; Andriamampionona, A. G.B.; Andrianina, L.; Anele, A.; Angelin, R.; Anjar, N.; Antùnez, O.; Antwi-Kusi, Akwasi; Anyanwu, L. J.C.; Aribi, A. A.; Arowolo, O. A.; Arrey, O.; Assefa, S. B.; Assoum, Guy; Athanse, V.; Athombo, J. S.; Atiku, M.; Atito-Narh, E.; Atomabe, Anatole; Attia, A.; Aungraheeta, M.; Aurélia, D. M.A.; Ayandipo, O. O.; Ayebale, A. E.T.; Azzaidey, H. M.Z.; Babajee, N. B.; Badi, H. B.; Badianga, E. K.; Baghni, R. B.; Bahta, M. T.; Bai, M.; Baitchu, Y.; Baloyi, A. M.; Bamuza, K. A.; Bamuza, M. I.; Bangure, L.; Bankole, O. B.; Barongo, M. L.; Barow, M. M.; Bashiya, L.; Basson, C. H.; Bechan, Sudha; Belhaj, S.; Ben Mansour, M. M.; Benali, D.; Benamour, A. S.B.; Berhe, A.; Bertie, J. D.; Bester, J. J.A.; Bester, M.; Bezuidenhout, J. D.; Bhagwan, K.; Bhagwandass, D. R.; Bhat, K. A.P.; Bhuiyan, M. M.Z.U.; Bigirimana, F.; Bikuelo, C. J.; Bilby, B. E.; Bingidimi, S. S.; Bischof, K. E.; Bishop, David G.; Bitta, C.; Bittaye, M.; Biyase, Thuli; Blake, C. A.; Blignaut, E.; Blignaut, F.; BN Tanjong, B. N.; Bogoslovskiy, A.; Boloko, P. M.; Boodhun, S. K.B.; Bori, I.; Boufas, F.; Brand, M.; Brouckaert, Nicholas T.; Bruwer, J. D.; Buccimazza, I.; Bula Bula, I. M.; Bulamba, Fred; Businge, B. C.; Bwambale, Y. B.; Cacala, S. R.C.; Cadersa, M. A.; Cairns, Chris; Carlos, F.; Casey, M. E.; Castro, A. C.; Chabayanzara, N. D.; Chaibou, M. S.; Chaibva, T. N.O.; Chakafa, N. K.; Chalo, C.; Changfoot, C.; Chari, M. C.; Chelbi, L.; Chibanda, J. T.; Chifamba, H. N.; Chikh, N.; Chikumba, E.; Chimberengwa, P.; Chirengwa, J.; Chitungo, F. M.; Chiwanga, M. C.; Chokoe, M. M.; Chokwe, T. M.; Chrirangi, B.; Christian, M.; Church, B.; Cisekedi, J. C.; Clegg-Lamptey, J. N.; Cloete, Estie; Coltman, Megan; Conradie, W.; Constance, N.; Coulibaly, Youssouf; Cronje, L.; Da Silva, M. A.; Daddy, H.; Dahim, L.; Daliri, D.; Dambaki, M. S.; Dasrath, A.; Davids, J. G.; Davies, Gareth L.; De Lange, J. T.; de Wet, J. B.; Dedekind, B.; Degaulle, M. A.; Dehal, V.; Deka, P. D.; Delinikaytis, S.; Desalu, I. S.; Dewanou, Hubert; Deye, MB Moussa; Dhege, C.; Diale, B. S.G.; Dibwe, D. F.; Diedericks, B. J.S.; Dippenaar, J. M.; Dippenaar, L.; Diyoyo, M. P.; Djessouho, Edith; Dlamini, S. N.; Dodiyi-Manuel, A.; Dokolwana, B. A.; Domoyyeri, D. P.; Drummond, Leanne W.; du Plessis, D. E.; du Plessis, W. M.; du Preez, L. J.; Dube, K.; Dube, N. Z.; Dullab, K. D.; Duvenhage, R.; Echem, R. C.; Edaigbini, S. A.; Egote, A. K.; Ehouni, A.; Ekwen, G.; Ekwunife, N. C.; El Hensheri, M.; Elfaghi, I. E.; Elfagieh, M. A.; Elfallah, S.; Elgelany, S.; Elghallal, A. M.; Elghandouri, M. G.; Elghazal, Z. S.; Elghobashy, A. M.; Elharati, F. T.; Elkhwildi, R. M.; Ellis, S.; Elmadani, L.; Elmadany, H. B.; Elmehdawi, H.; Elmgadmi, A.; Eloi, H.; Elrafifi, D.; Elsaadi, G.; Elsaity, R. B.; Elshikhy, A.; Eltaguri, M.; Elwerfelli, A.; Elyasir, I. E.; Elzoway, A. Z.; Elzufri, A. M.; Enendu, E. O.; Enicker, B. C.; Enwerem, E. O.; Esayas, R.; Eshtiwi, M.; Eshwehdi, A. A.; Esterhuizen, J. L.; Etuk, E. B.; Eurayet, O.; Eyelade, O. R.; Fanjandrainy, R. F.; Fanou, Lionelle; Farina, Z.; Fawzy, Maher; Feituri, A.; Fernandes, N. L.; Ford, L. M.; François, T.; Freeman, T.; Freeman, Y. B.M.; Gacii, V. M.; Gadi, B.; Gagara, M.; Gakenia, A.; Gallou, P. D.; Gama, G. G.N.; Gamal, M. G.; Gandy, Y. G.; Ganesh, A.; Gangaly, Diallo; Garcia, M.; Gatheru, A. P.; Gaya, S. S.D.; Gbéhadé, Oswald; Gerbel, G.; Ghnain, A.; Gigabhoy, R.; Giles, D. G.; Girmaye, G. T.; Gitau, S.; Githae, B.; Gitta, Said; Goga, Riaz; Gomati, A. A.G.; Gonzalez, M. E.; Gopall, J.; Gorelyk, O.; Gova, M.; Govender, K.; Govender, P.; Govender, S.; Govindasamy, V.; Green-Harris, J. T.K.; Greenwood, M. B.; Grey-Johnson, S. V.; Grobbelaar, Mariette; Groenewald, M. A.; Grünewald, K. K.; Guegni, Ambroise; Guenane, M.; Gueye, S.; Guezo, Marius; Gunguwo, T.; Gweder, M. G.; Gwila, M.; Habimana, L.; Hadecon, Rodrigue; Hadia, E.; Hamadi, L.; Hammouda, M.; Hampton, M. I.; Hanta, R.; Hardcastle, Tim C.; Hariniaina, J. A.; Hariparsad, S.; Harissou, A. H.; Harrichandparsad, R.; Hasan, S. H.A.; Hashmi, H. B.; Hayes, M. P.; Hdud, A.; Hebli, S. H.; Heerah, H. M.S.N.; Hersi, S.; Hery, A. H.; Hewitt-Smith, Adam; Hlako, T. C.; Hodges, S. C.H.; Hodgson, Richard Eric; Hokoma, M.; Holder, H.; Holford, E. B.; Horugavye, E.; Houston, C.; Hove, M.; Hugo, D.; Human, C. M.; Hurri, H.; Huwidi, O.; Ibrahim, A. I.; Ibrahim, Traoré; Idowu, O. K.; Igaga, I. E.; Igenge, John; Ihezie, O.; Ikandi, K.; Ike, I. A.R.; Ikuku, J. J.N.; Ilbarasi, M. N.; Ilunga, I. B.B.; Ilunga, J. P.M.; Imbangu, N. A.V.; Imessaoudene, Z.; Imposo, D. H.; Iraya, A. M.; Isaacs, M.; Isiguzo, M.; Issoufou, A.; Izquirdo, P.; Jaber, A.; Jaganath, U. V.; Jallow, C. S.; Jamabo, S.; Jamal, Z. S.; Janneh, L.; Jannetjies, M. J.; Jasim, I.; Jaworska, Megan AJ; Jay Narain, S.; Jermi, K.; Jimoh, R.; Jithoo, S.; Johnson, M.; Joomye, S.; Judicael, R. M.; Judicaël, M.; Juwid, A.; Jwambi, L. P.; Kabango, R.; Kabangu, J. K.; Kabatoro, D. K.; Kabongo, A. N.; Kabongo, K.; Kabongo, L. T.; Kabongo, M. D.; Kady, N.; Kafu, S.; Kaggya, M.; Kaholongo, B. N.K.; Kairuki, P. C.K.; Kakololo, S. I.; Kakudji, K.; Kalisa, Amina; Kalisa, R.; Kalufwelu, M. R.; Kalume, S.; Kamanda, R. J.; Kangili, M. K.; Kanoun, H.

In: The Lancet, Vol. 391, No. 10130, 21.04.2018, p. 1589-1598.

Research output: Contribution to journalArticle

Biccard, BM, Madiba, TE, Kluyts, HL, Munlemvo, DM, Madzimbamuto, FD, Basenero, A, Gordon, CS, Youssouf, C, Rakotoarison, SR, Gobin, V, Samateh, AL, Sani, CM, Omigbodun, AO, Amanor-Boadu, SD, Tumukunde, JT, Esterhuizen, TM, Manach, YL, Forget, P, Elkhogia, AM, Mehyaoui, RM, Zoumeno, E, Ndayisaba, G, Ndasi, H, Ndonga, AKN, Ngumi, ZWW, Patel, UP, Ashebir, DZ, Antwi-Kusi, AAK, Mbwele, B, Sama, HD, Elfiky, M, Fawzy, MA, Pearse, RM, Abadagan, H, Abbas, N, Abdelatif, AI, Abdoulaye, T, Abd-rouf, A, Abduljalil, A, Abdulrahman, A, Abdurazig, S, Abokris, A, Abozaid, W, Abugassa, SOA, Abuhdema, F, Abujanah, SA, Abusamra, R, Abushnaf, A, Abusnina, SA, Abuzalout, TS, Ackermann, HM, Adamu, YB, Addanfour, A, Adeleke, DM, Adigun, TA, Adisa, AO, Adjignon, SV, Adu-Aryee, NA, Afolabi, BB, Agaba, AFX, Agaba, PKA, Aghadi, K, Agilla, H, Ahmed, B, Ahmed, EZ, Ahmed, AJ, Ahmed, M, Ahossi, R, Aji, SA, Akanyun, S, Akhideno, I, Akhter, M, Akinyemi, OA, Akkari, M, Akodjenou, J, AL Samateh, AL, al Shams, ES, Alagbe-Briggs, OT, Alakkari, EA, Alalem, RB, Alashhab, M, Alatise, OI, Alatresh, A, Alayeb Alayeb, MSI, Albakosh, BA, Albert, F, Alberts, ANJD, Aldarrat, AD, Alfari, A, Alfetore, A, Algbali, M, Algddar, A, Algedar, HA, Alghafoud, IA, Alghazali, A, Alhajj, M, Alhendery Alhendery, A, Alhoty, FFH, Ali, A, Ali, YA, Alioune, BS, Alkassem, MA, Alkchr, MA, Alkesa, TS, Alkilani, A, Alkobty Alkobty, F, Allaye, T, Alleesaib, SBM, Alli, A, Allopi, K, Allorto, NL, Almajbery, A, Almesmary, R, Almisslati, SHA, Almoraid, F, Alobeidi, H, Alomami, MA, Alphonsus, CS, Alqawi, OA, Alraheem, AA, Alsabri, SA, Alsayed, A, Alsellabi, B, Al-Serksi, M, Alshareef, MSA, Altagazi, AA, Aluvale, JS, Alwahedi, HW, Alzahra, EA, Alzarouk, MA, Al-Zubaidy, K, Amadou, M, Amer, AA, Amisi, BT, Amuthenu, MA, Anabah, TWA, Anani, F, Anderson, PGR, Andriamampionona, AGB, Andrianina, L, Anele, A, Angelin, R, Anjar, N, Antùnez, O, Antwi-Kusi, A, Anyanwu, LJC, Aribi, AA, Arowolo, OA, Arrey, O, Assefa, SB, Assoum, G, Athanse, V, Athombo, JS, Atiku, M, Atito-Narh, E, Atomabe, A, Attia, A, Aungraheeta, M, Aurélia, DMA, Ayandipo, OO, Ayebale, AET, Azzaidey, HMZ, Babajee, NB, Badi, HB, Badianga, EK, Baghni, RB, Bahta, MT, Bai, M, Baitchu, Y, Baloyi, AM, Bamuza, KA, Bamuza, MI, Bangure, L, Bankole, OB, Barongo, ML, Barow, MM, Bashiya, L, Basson, CH, Bechan, S, Belhaj, S, Ben Mansour, MM, Benali, D, Benamour, ASB, Berhe, A, Bertie, JD, Bester, JJA, Bester, M, Bezuidenhout, JD, Bhagwan, K, Bhagwandass, DR, Bhat, KAP, Bhuiyan, MMZU, Bigirimana, F, Bikuelo, CJ, Bilby, BE, Bingidimi, SS, Bischof, KE, Bishop, DG, Bitta, C, Bittaye, M, Biyase, T, Blake, CA, Blignaut, E, Blignaut, F, BN Tanjong, BN, Bogoslovskiy, A, Boloko, PM, Boodhun, SKB, Bori, I, Boufas, F, Brand, M, Brouckaert, NT, Bruwer, JD, Buccimazza, I, Bula Bula, IM, Bulamba, F, Businge, BC, Bwambale, YB, Cacala, SRC, Cadersa, MA, Cairns, C, Carlos, F, Casey, ME, Castro, AC, Chabayanzara, ND, Chaibou, MS, Chaibva, TNO, Chakafa, NK, Chalo, C, Changfoot, C, Chari, MC, Chelbi, L, Chibanda, JT, Chifamba, HN, Chikh, N, Chikumba, E, Chimberengwa, P, Chirengwa, J, Chitungo, FM, Chiwanga, MC, Chokoe, MM, Chokwe, TM, Chrirangi, B, Christian, M, Church, B, Cisekedi, JC, Clegg-Lamptey, JN, Cloete, E, Coltman, M, Conradie, W, Constance, N, Coulibaly, Y, Cronje, L, Da Silva, MA, Daddy, H, Dahim, L, Daliri, D, Dambaki, MS, Dasrath, A, Davids, JG, Davies, GL, De Lange, JT, de Wet, JB, Dedekind, B, Degaulle, MA, Dehal, V, Deka, PD, Delinikaytis, S, Desalu, IS, Dewanou, H, Deye, MBM, Dhege, C, Diale, BSG, Dibwe, DF, Diedericks, BJS, Dippenaar, JM, Dippenaar, L, Diyoyo, MP, Djessouho, E, Dlamini, SN, Dodiyi-Manuel, A, Dokolwana, BA, Domoyyeri, DP, Drummond, LW, du Plessis, DE, du Plessis, WM, du Preez, LJ, Dube, K, Dube, NZ, Dullab, KD, Duvenhage, R, Echem, RC, Edaigbini, SA, Egote, AK, Ehouni, A, Ekwen, G, Ekwunife, NC, El Hensheri, M, Elfaghi, IE, Elfagieh, MA, Elfallah, S, Elgelany, S, Elghallal, AM, Elghandouri, MG, Elghazal, ZS, Elghobashy, AM, Elharati, FT, Elkhwildi, RM, Ellis, S, Elmadani, L, Elmadany, HB, Elmehdawi, H, Elmgadmi, A, Eloi, H, Elrafifi, D, Elsaadi, G, Elsaity, RB, Elshikhy, A, Eltaguri, M, Elwerfelli, A, Elyasir, IE, Elzoway, AZ, Elzufri, AM, Enendu, EO, Enicker, BC, Enwerem, EO, Esayas, R, Eshtiwi, M, Eshwehdi, AA, Esterhuizen, JL, Etuk, EB, Eurayet, O, Eyelade, OR, Fanjandrainy, RF, Fanou, L, Farina, Z, Fawzy, M, Feituri, A, Fernandes, NL, Ford, LM, François, T, Freeman, T, Freeman, YBM, Gacii, VM, Gadi, B, Gagara, M, Gakenia, A, Gallou, PD, Gama, GGN, Gamal, MG, Gandy, YG, Ganesh, A, Gangaly, D, Garcia, M, Gatheru, AP, Gaya, SSD, Gbéhadé, O, Gerbel, G, Ghnain, A, Gigabhoy, R, Giles, DG, Girmaye, GT, Gitau, S, Githae, B, Gitta, S, Goga, R, Gomati, AAG, Gonzalez, ME, Gopall, J, Gorelyk, O, Gova, M, Govender, K, Govender, P, Govender, S, Govindasamy, V, Green-Harris, JTK, Greenwood, MB, Grey-Johnson, SV, Grobbelaar, M, Groenewald, MA, Grünewald, KK, Guegni, A, Guenane, M, Gueye, S, Guezo, M, Gunguwo, T, Gweder, MG, Gwila, M, Habimana, L, Hadecon, R, Hadia, E, Hamadi, L, Hammouda, M, Hampton, MI, Hanta, R, Hardcastle, TC, Hariniaina, JA, Hariparsad, S, Harissou, AH, Harrichandparsad, R, Hasan, SHA, Hashmi, HB, Hayes, MP, Hdud, A, Hebli, SH, Heerah, HMSN, Hersi, S, Hery, AH, Hewitt-Smith, A, Hlako, TC, Hodges, SCH, Hodgson, RE, Hokoma, M, Holder, H, Holford, EB, Horugavye, E, Houston, C, Hove, M, Hugo, D, Human, CM, Hurri, H, Huwidi, O, Ibrahim, AI, Ibrahim, T, Idowu, OK, Igaga, IE, Igenge, J, Ihezie, O, Ikandi, K, Ike, IAR, Ikuku, JJN, Ilbarasi, MN, Ilunga, IBB, Ilunga, JPM, Imbangu, NAV, Imessaoudene, Z, Imposo, DH, Iraya, AM, Isaacs, M, Isiguzo, M, Issoufou, A, Izquirdo, P, Jaber, A, Jaganath, UV, Jallow, CS, Jamabo, S, Jamal, ZS, Janneh, L, Jannetjies, MJ, Jasim, I, Jaworska, MAJ, Jay Narain, S, Jermi, K, Jimoh, R, Jithoo, S, Johnson, M, Joomye, S, Judicael, RM, Judicaël, M, Juwid, A, Jwambi, LP, Kabango, R, Kabangu, JK, Kabatoro, DK, Kabongo, AN, Kabongo, K, Kabongo, LT, Kabongo, MD, Kady, N, Kafu, S, Kaggya, M, Kaholongo, BNK, Kairuki, PCK, Kakololo, SI, Kakudji, K, Kalisa, A, Kalisa, R, Kalufwelu, MR, Kalume, S, Kamanda, RJ, Kangili, MK & Kanoun, H 2018, 'Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study', The Lancet, vol. 391, no. 10130, pp. 1589-1598. https://doi.org/10.1016/S0140-6736(18)30001-1
Biccard BM, Madiba TE, Kluyts HL, Munlemvo DM, Madzimbamuto FD, Basenero A et al. Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. The Lancet. 2018 Apr 21;391(10130):1589-1598. https://doi.org/10.1016/S0140-6736(18)30001-1
Biccard, Bruce M. ; Madiba, Thandinkosi E. ; Kluyts, Hyla Louise ; Munlemvo, Dolly M. ; Madzimbamuto, Farai D. ; Basenero, Apollo ; Gordon, Christina Salmina ; Youssouf, Coulibaly ; Rakotoarison, Sylvia R. ; Gobin, Veekash ; Samateh, Ahmadou L. ; Sani, Chaibou M. ; Omigbodun, Akinyinka O. ; Amanor-Boadu, Simbo D. ; Tumukunde, Janat T. ; Esterhuizen, Tonya M. ; Manach, Yannick Le ; Forget, Patrice ; Elkhogia, Abdulaziz M. ; Mehyaoui, R. M. ; Zoumeno, Eugene ; Ndayisaba, Gabriel ; Ndasi, Henry ; Ndonga, Andrew K.N. ; Ngumi, Zipporah W.W. ; Patel, Ushmah P. ; Ashebir, Daniel Zemenfes ; Antwi-Kusi, Akwasi A.K. ; Mbwele, Bernard ; Sama, Hamza Doles ; Elfiky, Mahmoud ; Fawzy, Maher A. ; Pearse, Rupert M. ; Abadagan, Hippolyte ; Abbas, N. ; Abdelatif, A. Ibrahim ; Abdoulaye, Traoré ; Abd-rouf, A. ; Abduljalil, A. ; Abdulrahman, A. ; Abdurazig, S. ; Abokris, A. ; Abozaid, W. ; Abugassa, S. O.A. ; Abuhdema, F. ; Abujanah, S. A. ; Abusamra, R. ; Abushnaf, A. ; Abusnina, S. A. ; Abuzalout, T. S. ; Ackermann, H. M. ; Adamu, Y. B. ; Addanfour, A. ; Adeleke, D. M. ; Adigun, T. A. ; Adisa, A. O. ; Adjignon, Sèhivè Valéry ; Adu-Aryee, N. A. ; Afolabi, B. B. ; Agaba, A. F.X. ; Agaba, P. K.A. ; Aghadi, K. ; Agilla, H. ; Ahmed, B. ; Ahmed, El Z. ; Ahmed, Al J. ; Ahmed, M. ; Ahossi, Rene ; Aji, S. A. ; Akanyun, S. ; Akhideno, I. ; Akhter, M. ; Akinyemi, O. A. ; Akkari, M. ; Akodjenou, Joseph ; AL Samateh, A. L. ; al Shams, E. S. ; Alagbe-Briggs, O. T. ; Alakkari, E. A. ; Alalem, R. B. ; Alashhab, M. ; Alatise, O. I. ; Alatresh, A. ; Alayeb Alayeb, M. S.I. ; Albakosh, B. A. ; Albert, F. ; Alberts, A. N.J.D. ; Aldarrat, A. D. ; Alfari, A. ; Alfetore, A. ; Algbali, M. ; Algddar, A. ; Algedar, H. A. ; Alghafoud, I. A. ; Alghazali, A. ; Alhajj, M. ; Alhendery Alhendery, A. ; Alhoty, F. F.H. ; Ali, A. ; Ali, Y. A. ; Alioune, Beye Seïdina ; Alkassem, M. A. ; Alkchr, M. A. ; Alkesa, T. S. ; Alkilani, A. ; Alkobty Alkobty, F. ; Allaye, Thomas ; Alleesaib, S. B.M. ; Alli, A. ; Allopi, K. ; Allorto, N. L. ; Almajbery, A. ; Almesmary, R. ; Almisslati, S. H.A. ; Almoraid, F. ; Alobeidi, H. ; Alomami, M. A. ; Alphonsus, Christella S. ; Alqawi, O. A. ; Alraheem, A. A. ; Alsabri, S. A. ; Alsayed, A. ; Alsellabi, B. ; Al-Serksi, M. ; Alshareef, M. S.A. ; Altagazi, A. A. ; Aluvale, J. S. ; Alwahedi, H. W. ; Alzahra, E. A. ; Alzarouk, M. A. ; Al-Zubaidy, K. ; Amadou, Maiga ; Amer, Al A. ; Amisi, B. T. ; Amuthenu, M. A. ; Anabah, T. W.A. ; Anani, Felix ; Anderson, P. G.R. ; Andriamampionona, A. G.B. ; Andrianina, L. ; Anele, A. ; Angelin, R. ; Anjar, N. ; Antùnez, O. ; Antwi-Kusi, Akwasi ; Anyanwu, L. J.C. ; Aribi, A. A. ; Arowolo, O. A. ; Arrey, O. ; Assefa, S. B. ; Assoum, Guy ; Athanse, V. ; Athombo, J. S. ; Atiku, M. ; Atito-Narh, E. ; Atomabe, Anatole ; Attia, A. ; Aungraheeta, M. ; Aurélia, D. M.A. ; Ayandipo, O. O. ; Ayebale, A. E.T. ; Azzaidey, H. M.Z. ; Babajee, N. B. ; Badi, H. B. ; Badianga, E. K. ; Baghni, R. B. ; Bahta, M. T. ; Bai, M. ; Baitchu, Y. ; Baloyi, A. M. ; Bamuza, K. A. ; Bamuza, M. I. ; Bangure, L. ; Bankole, O. B. ; Barongo, M. L. ; Barow, M. M. ; Bashiya, L. ; Basson, C. H. ; Bechan, Sudha ; Belhaj, S. ; Ben Mansour, M. M. ; Benali, D. ; Benamour, A. S.B. ; Berhe, A. ; Bertie, J. D. ; Bester, J. J.A. ; Bester, M. ; Bezuidenhout, J. D. ; Bhagwan, K. ; Bhagwandass, D. R. ; Bhat, K. A.P. ; Bhuiyan, M. M.Z.U. ; Bigirimana, F. ; Bikuelo, C. J. ; Bilby, B. E. ; Bingidimi, S. S. ; Bischof, K. E. ; Bishop, David G. ; Bitta, C. ; Bittaye, M. ; Biyase, Thuli ; Blake, C. A. ; Blignaut, E. ; Blignaut, F. ; BN Tanjong, B. N. ; Bogoslovskiy, A. ; Boloko, P. M. ; Boodhun, S. K.B. ; Bori, I. ; Boufas, F. ; Brand, M. ; Brouckaert, Nicholas T. ; Bruwer, J. D. ; Buccimazza, I. ; Bula Bula, I. M. ; Bulamba, Fred ; Businge, B. C. ; Bwambale, Y. B. ; Cacala, S. R.C. ; Cadersa, M. A. ; Cairns, Chris ; Carlos, F. ; Casey, M. E. ; Castro, A. C. ; Chabayanzara, N. D. ; Chaibou, M. S. ; Chaibva, T. N.O. ; Chakafa, N. K. ; Chalo, C. ; Changfoot, C. ; Chari, M. C. ; Chelbi, L. ; Chibanda, J. T. ; Chifamba, H. N. ; Chikh, N. ; Chikumba, E. ; Chimberengwa, P. ; Chirengwa, J. ; Chitungo, F. M. ; Chiwanga, M. C. ; Chokoe, M. M. ; Chokwe, T. M. ; Chrirangi, B. ; Christian, M. ; Church, B. ; Cisekedi, J. C. ; Clegg-Lamptey, J. N. ; Cloete, Estie ; Coltman, Megan ; Conradie, W. ; Constance, N. ; Coulibaly, Youssouf ; Cronje, L. ; Da Silva, M. A. ; Daddy, H. ; Dahim, L. ; Daliri, D. ; Dambaki, M. S. ; Dasrath, A. ; Davids, J. G. ; Davies, Gareth L. ; De Lange, J. T. ; de Wet, J. B. ; Dedekind, B. ; Degaulle, M. A. ; Dehal, V. ; Deka, P. D. ; Delinikaytis, S. ; Desalu, I. S. ; Dewanou, Hubert ; Deye, MB Moussa ; Dhege, C. ; Diale, B. S.G. ; Dibwe, D. F. ; Diedericks, B. J.S. ; Dippenaar, J. M. ; Dippenaar, L. ; Diyoyo, M. P. ; Djessouho, Edith ; Dlamini, S. N. ; Dodiyi-Manuel, A. ; Dokolwana, B. A. ; Domoyyeri, D. P. ; Drummond, Leanne W. ; du Plessis, D. E. ; du Plessis, W. M. ; du Preez, L. J. ; Dube, K. ; Dube, N. Z. ; Dullab, K. D. ; Duvenhage, R. ; Echem, R. C. ; Edaigbini, S. A. ; Egote, A. K. ; Ehouni, A. ; Ekwen, G. ; Ekwunife, N. C. ; El Hensheri, M. ; Elfaghi, I. E. ; Elfagieh, M. A. ; Elfallah, S. ; Elgelany, S. ; Elghallal, A. M. ; Elghandouri, M. G. ; Elghazal, Z. S. ; Elghobashy, A. M. ; Elharati, F. T. ; Elkhwildi, R. M. ; Ellis, S. ; Elmadani, L. ; Elmadany, H. B. ; Elmehdawi, H. ; Elmgadmi, A. ; Eloi, H. ; Elrafifi, D. ; Elsaadi, G. ; Elsaity, R. B. ; Elshikhy, A. ; Eltaguri, M. ; Elwerfelli, A. ; Elyasir, I. E. ; Elzoway, A. Z. ; Elzufri, A. M. ; Enendu, E. O. ; Enicker, B. C. ; Enwerem, E. O. ; Esayas, R. ; Eshtiwi, M. ; Eshwehdi, A. A. ; Esterhuizen, J. L. ; Etuk, E. B. ; Eurayet, O. ; Eyelade, O. R. ; Fanjandrainy, R. F. ; Fanou, Lionelle ; Farina, Z. ; Fawzy, Maher ; Feituri, A. ; Fernandes, N. L. ; Ford, L. M. ; François, T. ; Freeman, T. ; Freeman, Y. B.M. ; Gacii, V. M. ; Gadi, B. ; Gagara, M. ; Gakenia, A. ; Gallou, P. D. ; Gama, G. G.N. ; Gamal, M. G. ; Gandy, Y. G. ; Ganesh, A. ; Gangaly, Diallo ; Garcia, M. ; Gatheru, A. P. ; Gaya, S. S.D. ; Gbéhadé, Oswald ; Gerbel, G. ; Ghnain, A. ; Gigabhoy, R. ; Giles, D. G. ; Girmaye, G. T. ; Gitau, S. ; Githae, B. ; Gitta, Said ; Goga, Riaz ; Gomati, A. A.G. ; Gonzalez, M. E. ; Gopall, J. ; Gorelyk, O. ; Gova, M. ; Govender, K. ; Govender, P. ; Govender, S. ; Govindasamy, V. ; Green-Harris, J. T.K. ; Greenwood, M. B. ; Grey-Johnson, S. V. ; Grobbelaar, Mariette ; Groenewald, M. A. ; Grünewald, K. K. ; Guegni, Ambroise ; Guenane, M. ; Gueye, S. ; Guezo, Marius ; Gunguwo, T. ; Gweder, M. G. ; Gwila, M. ; Habimana, L. ; Hadecon, Rodrigue ; Hadia, E. ; Hamadi, L. ; Hammouda, M. ; Hampton, M. I. ; Hanta, R. ; Hardcastle, Tim C. ; Hariniaina, J. A. ; Hariparsad, S. ; Harissou, A. H. ; Harrichandparsad, R. ; Hasan, S. H.A. ; Hashmi, H. B. ; Hayes, M. P. ; Hdud, A. ; Hebli, S. H. ; Heerah, H. M.S.N. ; Hersi, S. ; Hery, A. H. ; Hewitt-Smith, Adam ; Hlako, T. C. ; Hodges, S. C.H. ; Hodgson, Richard Eric ; Hokoma, M. ; Holder, H. ; Holford, E. B. ; Horugavye, E. ; Houston, C. ; Hove, M. ; Hugo, D. ; Human, C. M. ; Hurri, H. ; Huwidi, O. ; Ibrahim, A. I. ; Ibrahim, Traoré ; Idowu, O. K. ; Igaga, I. E. ; Igenge, John ; Ihezie, O. ; Ikandi, K. ; Ike, I. A.R. ; Ikuku, J. J.N. ; Ilbarasi, M. N. ; Ilunga, I. B.B. ; Ilunga, J. P.M. ; Imbangu, N. A.V. ; Imessaoudene, Z. ; Imposo, D. H. ; Iraya, A. M. ; Isaacs, M. ; Isiguzo, M. ; Issoufou, A. ; Izquirdo, P. ; Jaber, A. ; Jaganath, U. V. ; Jallow, C. S. ; Jamabo, S. ; Jamal, Z. S. ; Janneh, L. ; Jannetjies, M. J. ; Jasim, I. ; Jaworska, Megan AJ ; Jay Narain, S. ; Jermi, K. ; Jimoh, R. ; Jithoo, S. ; Johnson, M. ; Joomye, S. ; Judicael, R. M. ; Judicaël, M. ; Juwid, A. ; Jwambi, L. P. ; Kabango, R. ; Kabangu, J. K. ; Kabatoro, D. K. ; Kabongo, A. N. ; Kabongo, K. ; Kabongo, L. T. ; Kabongo, M. D. ; Kady, N. ; Kafu, S. ; Kaggya, M. ; Kaholongo, B. N.K. ; Kairuki, P. C.K. ; Kakololo, S. I. ; Kakudji, K. ; Kalisa, Amina ; Kalisa, R. ; Kalufwelu, M. R. ; Kalume, S. ; Kamanda, R. J. ; Kangili, M. K. ; Kanoun, H. / Perioperative patient outcomes in the African Surgical Outcomes Study : a 7-day prospective observational cohort study. In: The Lancet. 2018 ; Vol. 391, No. 10130. pp. 1589-1598.
@article{889879bd68834f9488efb315ed41d14e,
title = "Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study",
abstract = "Background: There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. Methods: We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90{\%} of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n ({\%}), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899). Findings: We recruited 11 422 patients (median 29 [IQR 10–70]) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000–2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2–1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65–578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years [SD 16·1]), with a lower risk profile (American Society of Anesthesiologists median score 1 [IQR 1–2]) than reported in high-income countries. 1253 (11{\%}) patients were infected with HIV, 6504 procedures (57{\%}) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33{\%}). Postoperative complications occurred in 1977 (18·2{\%}, 95{\%} CI 17·4–18·9]) of 10 885 patients. 239 (2·1{\%}) of 11 193 patients died, 225 (94·1{\%}) after the day of surgery. Infection was the most common complication (1156 [10·2{\%}] of 10 970 patients), of whom 112 (9·7{\%}) died. Interpretation: Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective. Funding: Medical Research Council of South Africa.",
author = "Biccard, {Bruce M.} and Madiba, {Thandinkosi E.} and Kluyts, {Hyla Louise} and Munlemvo, {Dolly M.} and Madzimbamuto, {Farai D.} and Apollo Basenero and Gordon, {Christina Salmina} and Coulibaly Youssouf and Rakotoarison, {Sylvia R.} and Veekash Gobin and Samateh, {Ahmadou L.} and Sani, {Chaibou M.} and Omigbodun, {Akinyinka O.} and Amanor-Boadu, {Simbo D.} and Tumukunde, {Janat T.} and Esterhuizen, {Tonya M.} and Manach, {Yannick Le} and Patrice Forget and Elkhogia, {Abdulaziz M.} and Mehyaoui, {R. M.} and Eugene Zoumeno and Gabriel Ndayisaba and Henry Ndasi and Ndonga, {Andrew K.N.} and Ngumi, {Zipporah W.W.} and Patel, {Ushmah P.} and Ashebir, {Daniel Zemenfes} and Antwi-Kusi, {Akwasi A.K.} and Bernard Mbwele and Sama, {Hamza Doles} and Mahmoud Elfiky and Fawzy, {Maher A.} and Pearse, {Rupert M.} and Hippolyte Abadagan and N. Abbas and Abdelatif, {A. Ibrahim} and Traor{\'e} Abdoulaye and A. Abd-rouf and A. Abduljalil and A. Abdulrahman and S. Abdurazig and A. Abokris and W. Abozaid and Abugassa, {S. O.A.} and F. Abuhdema and Abujanah, {S. A.} and R. Abusamra and A. Abushnaf and Abusnina, {S. A.} and Abuzalout, {T. S.} and Ackermann, {H. M.} and Adamu, {Y. B.} and A. Addanfour and Adeleke, {D. M.} and Adigun, {T. A.} and Adisa, {A. O.} and Adjignon, {S{\`e}hiv{\`e} Val{\'e}ry} and Adu-Aryee, {N. A.} and Afolabi, {B. B.} and Agaba, {A. F.X.} and Agaba, {P. K.A.} and K. Aghadi and H. Agilla and B. Ahmed and Ahmed, {El Z.} and Ahmed, {Al J.} and M. Ahmed and Rene Ahossi and Aji, {S. A.} and S. Akanyun and I. Akhideno and M. Akhter and Akinyemi, {O. A.} and M. Akkari and Joseph Akodjenou and {AL Samateh}, {A. L.} and {al Shams}, {E. S.} and Alagbe-Briggs, {O. T.} and Alakkari, {E. A.} and Alalem, {R. B.} and M. Alashhab and Alatise, {O. I.} and A. Alatresh and {Alayeb Alayeb}, {M. S.I.} and Albakosh, {B. A.} and F. Albert and Alberts, {A. N.J.D.} and Aldarrat, {A. D.} and A. Alfari and A. Alfetore and M. Algbali and A. Algddar and Algedar, {H. A.} and Alghafoud, {I. A.} and A. Alghazali and M. Alhajj and {Alhendery Alhendery}, A. and Alhoty, {F. F.H.} and A. Ali and Ali, {Y. A.} and Alioune, {Beye Se{\"i}dina} and Alkassem, {M. A.} and Alkchr, {M. A.} and Alkesa, {T. S.} and A. Alkilani and {Alkobty Alkobty}, F. and Thomas Allaye and Alleesaib, {S. B.M.} and A. Alli and K. Allopi and Allorto, {N. L.} and A. Almajbery and R. Almesmary and Almisslati, {S. H.A.} and F. Almoraid and H. Alobeidi and Alomami, {M. A.} and Alphonsus, {Christella S.} and Alqawi, {O. A.} and Alraheem, {A. A.} and Alsabri, {S. A.} and A. Alsayed and B. Alsellabi and M. Al-Serksi and Alshareef, {M. S.A.} and Altagazi, {A. A.} and Aluvale, {J. S.} and Alwahedi, {H. W.} and Alzahra, {E. A.} and Alzarouk, {M. A.} and K. Al-Zubaidy and Maiga Amadou and Amer, {Al A.} and Amisi, {B. T.} and Amuthenu, {M. A.} and Anabah, {T. W.A.} and Felix Anani and Anderson, {P. G.R.} and Andriamampionona, {A. G.B.} and L. Andrianina and A. Anele and R. Angelin and N. Anjar and O. Ant{\`u}nez and Akwasi Antwi-Kusi and Anyanwu, {L. J.C.} and Aribi, {A. A.} and Arowolo, {O. A.} and O. Arrey and Assefa, {S. B.} and Guy Assoum and V. Athanse and Athombo, {J. S.} and M. Atiku and E. Atito-Narh and Anatole Atomabe and A. Attia and M. Aungraheeta and Aur{\'e}lia, {D. M.A.} and Ayandipo, {O. O.} and Ayebale, {A. E.T.} and Azzaidey, {H. M.Z.} and Babajee, {N. B.} and Badi, {H. B.} and Badianga, {E. K.} and Baghni, {R. B.} and Bahta, {M. T.} and M. Bai and Y. Baitchu and Baloyi, {A. M.} and Bamuza, {K. A.} and Bamuza, {M. I.} and L. Bangure and Bankole, {O. B.} and Barongo, {M. L.} and Barow, {M. M.} and L. Bashiya and Basson, {C. H.} and Sudha Bechan and S. Belhaj and {Ben Mansour}, {M. M.} and D. Benali and Benamour, {A. S.B.} and A. Berhe and Bertie, {J. D.} and Bester, {J. J.A.} and M. Bester and Bezuidenhout, {J. D.} and K. Bhagwan and Bhagwandass, {D. R.} and Bhat, {K. A.P.} and Bhuiyan, {M. M.Z.U.} and F. Bigirimana and Bikuelo, {C. J.} and Bilby, {B. E.} and Bingidimi, {S. S.} and Bischof, {K. E.} and Bishop, {David G.} and C. Bitta and M. Bittaye and Thuli Biyase and Blake, {C. A.} and E. Blignaut and F. Blignaut and {BN Tanjong}, {B. N.} and A. Bogoslovskiy and Boloko, {P. M.} and Boodhun, {S. K.B.} and I. Bori and F. Boufas and M. Brand and Brouckaert, {Nicholas T.} and Bruwer, {J. D.} and I. Buccimazza and {Bula Bula}, {I. M.} and Fred Bulamba and Businge, {B. C.} and Bwambale, {Y. B.} and Cacala, {S. R.C.} and Cadersa, {M. A.} and Chris Cairns and F. Carlos and Casey, {M. E.} and Castro, {A. C.} and Chabayanzara, {N. D.} and Chaibou, {M. S.} and Chaibva, {T. N.O.} and Chakafa, {N. K.} and C. Chalo and C. Changfoot and Chari, {M. C.} and L. Chelbi and Chibanda, {J. T.} and Chifamba, {H. N.} and N. Chikh and E. Chikumba and P. Chimberengwa and J. Chirengwa and Chitungo, {F. M.} and Chiwanga, {M. C.} and Chokoe, {M. M.} and Chokwe, {T. M.} and B. Chrirangi and M. Christian and B. Church and Cisekedi, {J. C.} and Clegg-Lamptey, {J. N.} and Estie Cloete and Megan Coltman and W. Conradie and N. Constance and Youssouf Coulibaly and L. Cronje and {Da Silva}, {M. A.} and H. Daddy and L. Dahim and D. Daliri and Dambaki, {M. S.} and A. Dasrath and Davids, {J. G.} and Davies, {Gareth L.} and {De Lange}, {J. T.} and {de Wet}, {J. B.} and B. Dedekind and Degaulle, {M. A.} and V. Dehal and Deka, {P. D.} and S. Delinikaytis and Desalu, {I. S.} and Hubert Dewanou and Deye, {MB Moussa} and C. Dhege and Diale, {B. S.G.} and Dibwe, {D. F.} and Diedericks, {B. J.S.} and Dippenaar, {J. M.} and L. Dippenaar and Diyoyo, {M. P.} and Edith Djessouho and Dlamini, {S. N.} and A. Dodiyi-Manuel and Dokolwana, {B. A.} and Domoyyeri, {D. P.} and Drummond, {Leanne W.} and {du Plessis}, {D. E.} and {du Plessis}, {W. M.} and {du Preez}, {L. J.} and K. Dube and Dube, {N. Z.} and Dullab, {K. D.} and R. Duvenhage and Echem, {R. C.} and Edaigbini, {S. A.} and Egote, {A. K.} and A. Ehouni and G. Ekwen and Ekwunife, {N. C.} and {El Hensheri}, M. and Elfaghi, {I. E.} and Elfagieh, {M. A.} and S. Elfallah and S. Elgelany and Elghallal, {A. M.} and Elghandouri, {M. G.} and Elghazal, {Z. S.} and Elghobashy, {A. M.} and Elharati, {F. T.} and Elkhwildi, {R. M.} and S. Ellis and L. Elmadani and Elmadany, {H. B.} and H. Elmehdawi and A. Elmgadmi and H. Eloi and D. Elrafifi and G. Elsaadi and Elsaity, {R. B.} and A. Elshikhy and M. Eltaguri and A. Elwerfelli and Elyasir, {I. E.} and Elzoway, {A. Z.} and Elzufri, {A. M.} and Enendu, {E. O.} and Enicker, {B. C.} and Enwerem, {E. O.} and R. Esayas and M. Eshtiwi and Eshwehdi, {A. A.} and Esterhuizen, {J. L.} and Etuk, {E. B.} and O. Eurayet and Eyelade, {O. R.} and Fanjandrainy, {R. F.} and Lionelle Fanou and Z. Farina and Maher Fawzy and A. Feituri and Fernandes, {N. L.} and Ford, {L. M.} and T. Fran{\cc}ois and T. Freeman and Freeman, {Y. B.M.} and Gacii, {V. M.} and B. Gadi and M. Gagara and A. Gakenia and Gallou, {P. D.} and Gama, {G. G.N.} and Gamal, {M. G.} and Gandy, {Y. G.} and A. Ganesh and Diallo Gangaly and M. Garcia and Gatheru, {A. P.} and Gaya, {S. S.D.} and Oswald Gb{\'e}had{\'e} and G. Gerbel and A. Ghnain and R. Gigabhoy and Giles, {D. G.} and Girmaye, {G. T.} and S. Gitau and B. Githae and Said Gitta and Riaz Goga and Gomati, {A. A.G.} and Gonzalez, {M. E.} and J. Gopall and O. Gorelyk and M. Gova and K. Govender and P. Govender and S. Govender and V. Govindasamy and Green-Harris, {J. T.K.} and Greenwood, {M. B.} and Grey-Johnson, {S. V.} and Mariette Grobbelaar and Groenewald, {M. A.} and Gr{\"u}newald, {K. K.} and Ambroise Guegni and M. Guenane and S. Gueye and Marius Guezo and T. Gunguwo and Gweder, {M. G.} and M. Gwila and L. Habimana and Rodrigue Hadecon and E. Hadia and L. Hamadi and M. Hammouda and Hampton, {M. I.} and R. Hanta and Hardcastle, {Tim C.} and Hariniaina, {J. A.} and S. Hariparsad and Harissou, {A. H.} and R. Harrichandparsad and Hasan, {S. H.A.} and Hashmi, {H. B.} and Hayes, {M. P.} and A. Hdud and Hebli, {S. H.} and Heerah, {H. M.S.N.} and S. Hersi and Hery, {A. H.} and Adam Hewitt-Smith and Hlako, {T. C.} and Hodges, {S. C.H.} and Hodgson, {Richard Eric} and M. Hokoma and H. Holder and Holford, {E. B.} and E. Horugavye and C. Houston and M. Hove and D. Hugo and Human, {C. M.} and H. Hurri and O. Huwidi and Ibrahim, {A. I.} and Traor{\'e} Ibrahim and Idowu, {O. K.} and Igaga, {I. E.} and John Igenge and O. Ihezie and K. Ikandi and Ike, {I. A.R.} and Ikuku, {J. J.N.} and Ilbarasi, {M. N.} and Ilunga, {I. B.B.} and Ilunga, {J. P.M.} and Imbangu, {N. A.V.} and Z. Imessaoudene and Imposo, {D. H.} and Iraya, {A. M.} and M. Isaacs and M. Isiguzo and A. Issoufou and P. Izquirdo and A. Jaber and Jaganath, {U. V.} and Jallow, {C. S.} and S. Jamabo and Jamal, {Z. S.} and L. Janneh and Jannetjies, {M. J.} and I. Jasim and Jaworska, {Megan AJ} and {Jay Narain}, S. and K. Jermi and R. Jimoh and S. Jithoo and M. Johnson and S. Joomye and Judicael, {R. M.} and M. Judica{\"e}l and A. Juwid and Jwambi, {L. P.} and R. Kabango and Kabangu, {J. K.} and Kabatoro, {D. K.} and Kabongo, {A. N.} and K. Kabongo and Kabongo, {L. T.} and Kabongo, {M. D.} and N. Kady and S. Kafu and M. Kaggya and Kaholongo, {B. N.K.} and Kairuki, {P. C.K.} and Kakololo, {S. I.} and K. Kakudji and Amina Kalisa and R. Kalisa and Kalufwelu, {M. R.} and S. Kalume and Kamanda, {R. J.} and Kangili, {M. K.} and H. Kanoun",
year = "2018",
month = "4",
day = "21",
doi = "10.1016/S0140-6736(18)30001-1",
language = "English",
volume = "391",
pages = "1589--1598",
journal = "The Lancet",
issn = "0140-6736",
publisher = "ACADEMIC PRESS INC ELSEVIER SCIENCE",
number = "10130",

}

TY - JOUR

T1 - Perioperative patient outcomes in the African Surgical Outcomes Study

T2 - a 7-day prospective observational cohort study

AU - Biccard, Bruce M.

AU - Madiba, Thandinkosi E.

AU - Kluyts, Hyla Louise

AU - Munlemvo, Dolly M.

AU - Madzimbamuto, Farai D.

AU - Basenero, Apollo

AU - Gordon, Christina Salmina

AU - Youssouf, Coulibaly

AU - Rakotoarison, Sylvia R.

AU - Gobin, Veekash

AU - Samateh, Ahmadou L.

AU - Sani, Chaibou M.

AU - Omigbodun, Akinyinka O.

AU - Amanor-Boadu, Simbo D.

AU - Tumukunde, Janat T.

AU - Esterhuizen, Tonya M.

AU - Manach, Yannick Le

AU - Forget, Patrice

AU - Elkhogia, Abdulaziz M.

AU - Mehyaoui, R. M.

AU - Zoumeno, Eugene

AU - Ndayisaba, Gabriel

AU - Ndasi, Henry

AU - Ndonga, Andrew K.N.

AU - Ngumi, Zipporah W.W.

AU - Patel, Ushmah P.

AU - Ashebir, Daniel Zemenfes

AU - Antwi-Kusi, Akwasi A.K.

AU - Mbwele, Bernard

AU - Sama, Hamza Doles

AU - Elfiky, Mahmoud

AU - Fawzy, Maher A.

AU - Pearse, Rupert M.

AU - Abadagan, Hippolyte

AU - Abbas, N.

AU - Abdelatif, A. Ibrahim

AU - Abdoulaye, Traoré

AU - Abd-rouf, A.

AU - Abduljalil, A.

AU - Abdulrahman, A.

AU - Abdurazig, S.

AU - Abokris, A.

AU - Abozaid, W.

AU - Abugassa, S. O.A.

AU - Abuhdema, F.

AU - Abujanah, S. A.

AU - Abusamra, R.

AU - Abushnaf, A.

AU - Abusnina, S. A.

AU - Abuzalout, T. S.

AU - Ackermann, H. M.

AU - Adamu, Y. B.

AU - Addanfour, A.

AU - Adeleke, D. M.

AU - Adigun, T. A.

AU - Adisa, A. O.

AU - Adjignon, Sèhivè Valéry

AU - Adu-Aryee, N. A.

AU - Afolabi, B. B.

AU - Agaba, A. F.X.

AU - Agaba, P. K.A.

AU - Aghadi, K.

AU - Agilla, H.

AU - Ahmed, B.

AU - Ahmed, El Z.

AU - Ahmed, Al J.

AU - Ahmed, M.

AU - Ahossi, Rene

AU - Aji, S. A.

AU - Akanyun, S.

AU - Akhideno, I.

AU - Akhter, M.

AU - Akinyemi, O. A.

AU - Akkari, M.

AU - Akodjenou, Joseph

AU - AL Samateh, A. L.

AU - al Shams, E. S.

AU - Alagbe-Briggs, O. T.

AU - Alakkari, E. A.

AU - Alalem, R. B.

AU - Alashhab, M.

AU - Alatise, O. I.

AU - Alatresh, A.

AU - Alayeb Alayeb, M. S.I.

AU - Albakosh, B. A.

AU - Albert, F.

AU - Alberts, A. N.J.D.

AU - Aldarrat, A. D.

AU - Alfari, A.

AU - Alfetore, A.

AU - Algbali, M.

AU - Algddar, A.

AU - Algedar, H. A.

AU - Alghafoud, I. A.

AU - Alghazali, A.

AU - Alhajj, M.

AU - Alhendery Alhendery, A.

AU - Alhoty, F. F.H.

AU - Ali, A.

AU - Ali, Y. A.

AU - Alioune, Beye Seïdina

AU - Alkassem, M. A.

AU - Alkchr, M. A.

AU - Alkesa, T. S.

AU - Alkilani, A.

AU - Alkobty Alkobty, F.

AU - Allaye, Thomas

AU - Alleesaib, S. B.M.

AU - Alli, A.

AU - Allopi, K.

AU - Allorto, N. L.

AU - Almajbery, A.

AU - Almesmary, R.

AU - Almisslati, S. H.A.

AU - Almoraid, F.

AU - Alobeidi, H.

AU - Alomami, M. A.

AU - Alphonsus, Christella S.

AU - Alqawi, O. A.

AU - Alraheem, A. A.

AU - Alsabri, S. A.

AU - Alsayed, A.

AU - Alsellabi, B.

AU - Al-Serksi, M.

AU - Alshareef, M. S.A.

AU - Altagazi, A. A.

AU - Aluvale, J. S.

AU - Alwahedi, H. W.

AU - Alzahra, E. A.

AU - Alzarouk, M. A.

AU - Al-Zubaidy, K.

AU - Amadou, Maiga

AU - Amer, Al A.

AU - Amisi, B. T.

AU - Amuthenu, M. A.

AU - Anabah, T. W.A.

AU - Anani, Felix

AU - Anderson, P. G.R.

AU - Andriamampionona, A. G.B.

AU - Andrianina, L.

AU - Anele, A.

AU - Angelin, R.

AU - Anjar, N.

AU - Antùnez, O.

AU - Antwi-Kusi, Akwasi

AU - Anyanwu, L. J.C.

AU - Aribi, A. A.

AU - Arowolo, O. A.

AU - Arrey, O.

AU - Assefa, S. B.

AU - Assoum, Guy

AU - Athanse, V.

AU - Athombo, J. S.

AU - Atiku, M.

AU - Atito-Narh, E.

AU - Atomabe, Anatole

AU - Attia, A.

AU - Aungraheeta, M.

AU - Aurélia, D. M.A.

AU - Ayandipo, O. O.

AU - Ayebale, A. E.T.

AU - Azzaidey, H. M.Z.

AU - Babajee, N. B.

AU - Badi, H. B.

AU - Badianga, E. K.

AU - Baghni, R. B.

AU - Bahta, M. T.

AU - Bai, M.

AU - Baitchu, Y.

AU - Baloyi, A. M.

AU - Bamuza, K. A.

AU - Bamuza, M. I.

AU - Bangure, L.

AU - Bankole, O. B.

AU - Barongo, M. L.

AU - Barow, M. M.

AU - Bashiya, L.

AU - Basson, C. H.

AU - Bechan, Sudha

AU - Belhaj, S.

AU - Ben Mansour, M. M.

AU - Benali, D.

AU - Benamour, A. S.B.

AU - Berhe, A.

AU - Bertie, J. D.

AU - Bester, J. J.A.

AU - Bester, M.

AU - Bezuidenhout, J. D.

AU - Bhagwan, K.

AU - Bhagwandass, D. R.

AU - Bhat, K. A.P.

AU - Bhuiyan, M. M.Z.U.

AU - Bigirimana, F.

AU - Bikuelo, C. J.

AU - Bilby, B. E.

AU - Bingidimi, S. S.

AU - Bischof, K. E.

AU - Bishop, David G.

AU - Bitta, C.

AU - Bittaye, M.

AU - Biyase, Thuli

AU - Blake, C. A.

AU - Blignaut, E.

AU - Blignaut, F.

AU - BN Tanjong, B. N.

AU - Bogoslovskiy, A.

AU - Boloko, P. M.

AU - Boodhun, S. K.B.

AU - Bori, I.

AU - Boufas, F.

AU - Brand, M.

AU - Brouckaert, Nicholas T.

AU - Bruwer, J. D.

AU - Buccimazza, I.

AU - Bula Bula, I. M.

AU - Bulamba, Fred

AU - Businge, B. C.

AU - Bwambale, Y. B.

AU - Cacala, S. R.C.

AU - Cadersa, M. A.

AU - Cairns, Chris

AU - Carlos, F.

AU - Casey, M. E.

AU - Castro, A. C.

AU - Chabayanzara, N. D.

AU - Chaibou, M. S.

AU - Chaibva, T. N.O.

AU - Chakafa, N. K.

AU - Chalo, C.

AU - Changfoot, C.

AU - Chari, M. C.

AU - Chelbi, L.

AU - Chibanda, J. T.

AU - Chifamba, H. N.

AU - Chikh, N.

AU - Chikumba, E.

AU - Chimberengwa, P.

AU - Chirengwa, J.

AU - Chitungo, F. M.

AU - Chiwanga, M. C.

AU - Chokoe, M. M.

AU - Chokwe, T. M.

AU - Chrirangi, B.

AU - Christian, M.

AU - Church, B.

AU - Cisekedi, J. C.

AU - Clegg-Lamptey, J. N.

AU - Cloete, Estie

AU - Coltman, Megan

AU - Conradie, W.

AU - Constance, N.

AU - Coulibaly, Youssouf

AU - Cronje, L.

AU - Da Silva, M. A.

AU - Daddy, H.

AU - Dahim, L.

AU - Daliri, D.

AU - Dambaki, M. S.

AU - Dasrath, A.

AU - Davids, J. G.

AU - Davies, Gareth L.

AU - De Lange, J. T.

AU - de Wet, J. B.

AU - Dedekind, B.

AU - Degaulle, M. A.

AU - Dehal, V.

AU - Deka, P. D.

AU - Delinikaytis, S.

AU - Desalu, I. S.

AU - Dewanou, Hubert

AU - Deye, MB Moussa

AU - Dhege, C.

AU - Diale, B. S.G.

AU - Dibwe, D. F.

AU - Diedericks, B. J.S.

AU - Dippenaar, J. M.

AU - Dippenaar, L.

AU - Diyoyo, M. P.

AU - Djessouho, Edith

AU - Dlamini, S. N.

AU - Dodiyi-Manuel, A.

AU - Dokolwana, B. A.

AU - Domoyyeri, D. P.

AU - Drummond, Leanne W.

AU - du Plessis, D. E.

AU - du Plessis, W. M.

AU - du Preez, L. J.

AU - Dube, K.

AU - Dube, N. Z.

AU - Dullab, K. D.

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PY - 2018/4/21

Y1 - 2018/4/21

N2 - Background: There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. Methods: We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899). Findings: We recruited 11 422 patients (median 29 [IQR 10–70]) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000–2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2–1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65–578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years [SD 16·1]), with a lower risk profile (American Society of Anesthesiologists median score 1 [IQR 1–2]) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18·2%, 95% CI 17·4–18·9]) of 10 885 patients. 239 (2·1%) of 11 193 patients died, 225 (94·1%) after the day of surgery. Infection was the most common complication (1156 [10·2%] of 10 970 patients), of whom 112 (9·7%) died. Interpretation: Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective. Funding: Medical Research Council of South Africa.

AB - Background: There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa. Methods: We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899). Findings: We recruited 11 422 patients (median 29 [IQR 10–70]) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000–2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2–1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65–578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years [SD 16·1]), with a lower risk profile (American Society of Anesthesiologists median score 1 [IQR 1–2]) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18·2%, 95% CI 17·4–18·9]) of 10 885 patients. 239 (2·1%) of 11 193 patients died, 225 (94·1%) after the day of surgery. Infection was the most common complication (1156 [10·2%] of 10 970 patients), of whom 112 (9·7%) died. Interpretation: Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective. Funding: Medical Research Council of South Africa.

UR - http://www.mendeley.com/research/perioperative-patient-outcomes-african-surgical-outcomes-study-7day-prospective-observational-cohort-2

U2 - 10.1016/S0140-6736(18)30001-1

DO - 10.1016/S0140-6736(18)30001-1

M3 - Article

VL - 391

SP - 1589

EP - 1598

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10130

ER -