The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

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*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background
The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.

Methods
ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.

Results
The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.

Conclusions
This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.
Original languageEnglish
Pages (from-to)1357-1363
Number of pages7
JournalBritish Journal of Anaesthesia
Volume121
Issue number6
Early online date17 Sep 2018
DOIs
Publication statusPublished - Dec 2018

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Outcome Assessment (Health Care)
Hospital Mortality
Logistic Models
ROC Curve
Calibration
Cohort Studies
Smoking
Prospective Studies
Mortality
Population

Keywords

  • mortality
  • preoperative
  • risk assessment
  • risk stratification
  • surgery

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The ASOS Surgical Risk Calculator : development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications. / Kluyts, H.-L.; Le Manach, Y.; Munlemvo, D.M.; Madzimbamuto, F.; Basenero, A.; Coulibaly, Y.; Rakotoarison, R.R.; Gobin, V.; Samateh, A.L.; Chaibou, M.S.; Omigbodun, A.O.; Amanor-Boadu, S.D.; Tumukunde, J.; Madiba, T.E.; Pearse, R.M.; Biccard, B.M.; Abadagan, H.; Abbas, N.; Abdelatif, A.I.; Abdoulaye, T.; 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, S.V.; Adu-Aryee, N.A.; Afolabi, B.B.; Agaba, A.F.X.; Agaba, P.K.A.; Aghadi, K.; Agilla, H.; Ahmed, B.; Ahmed, E.-Z.; Ahmed, A.-J.; Ahmed, M.; Ahossi, R.; Aji, S.A.; Akanyun, S.; Akhideno, I.; Akhter, M.; Akinyemi, O.A.; Akkari, M.; Akodjenou, J.; 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.; Ali, A.; Alioune, B.S.; Alkassem, M.A.; Alkchr, M.A.; Alkesa, T.S.; Alkilani, A.; Alkobty Alkobty, F.; Allaye, T.; 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, C.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, M.; Amadou, M.; Amanor-Boadu, S.D.; Amer, A.-A.; Amisi, B.T.; Amuthenu, M.A.; Anabah, T.W.A.; Anani, F.; Anderson, P.G.R.; Andriamampionona, A.G.B.; 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Hodgson, R.E.; 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, T.; Idowu, O.K.; Igaga, I.E.; Igenge, J.; 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, M.A.J.; 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, A.; Kalisa, R.; Kalufwelu, M.R.; Kalume, S.; Kamanda, R.J.; Kangili, M.K.; Kanoun, H.; Kapesa; Kapp, P.; Karanja, J.K.; 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In: British Journal of Anaesthesia, Vol. 121, No. 6, 12.2018, p. 1357-1363.

Research output: Contribution to journalArticle

Kluyts, H-L, Le Manach, Y, Munlemvo, DM, Madzimbamuto, F, Basenero, A, Coulibaly, Y, Rakotoarison, RR, Gobin, V, Samateh, AL, Chaibou, MS, Omigbodun, AO, Amanor-Boadu, SD, Tumukunde, J, Madiba, TE, Pearse, RM, Biccard, BM, 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, E-Z, Ahmed, A-J, Ahmed, M, Ahossi, R, Aji, SA, Akanyun, S, Akhideno, I, Akhter, M, Akinyemi, OA, Akkari, M, Akodjenou, J, 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, Ali, A, 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, Amadou, M, Amanor-Boadu, SD, Amer, A-A, 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, Ashebir, DZ, 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, Basenero, A, 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, Biccard, BM, 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, 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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, Esterhuizen, TM, Etuk, EB, Eurayet, O, Eyelade, OR, Fanjandrainy, RF, Fanou, L, Farina, Z, Fawzy, M, Feituri, A, Fernandes, NL, Ford, LM, Forget, P, 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, Gobin, V, Goga, R, Gomati, AAG, Gonzalez, ME, Gopall, J, Gordon, CS, 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, 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In: British Journal of Anaesthesia. 2018 ; Vol. 121, No. 6. pp. 1357-1363.
@article{2e035d9fc161447aa82db619cac7483e,
title = "The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications",
abstract = "BackgroundThe African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.MethodsASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.ResultsThe model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8{\%}) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.ConclusionsThis simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.",
keywords = "mortality, preoperative, risk assessment, risk stratification, surgery",
author = "H.-L. Kluyts and {Le Manach}, Y. and D.M. Munlemvo and F. Madzimbamuto and A. Basenero and Y. Coulibaly and R.R. Rakotoarison and V. Gobin and A.L. Samateh and M.S. Chaibou and A.O. Omigbodun and S.D. Amanor-Boadu and J. Tumukunde and T.E. Madiba and R.M. Pearse and B.M. Biccard and H. Abadagan and N. Abbas and A.I. Abdelatif and T. Abdoulaye and A. Abd-rouf and A. Abduljalil and A. Abdulrahman and S. Abdurazig and A. Abokris and W. Abozaid and S.O.A. Abugassa and F. Abuhdema and S.A. Abujanah and R. Abusamra and A. Abushnaf and S.A. Abusnina and T.S. Abuzalout and H.M. Ackermann and Y.B. Adamu and A. Addanfour and D.M. Adeleke and T.A. Adigun and A.O. Adisa and S.V. Adjignon and N.A. Adu-Aryee and B.B. Afolabi and A.F.X. Agaba and P.K.A. Agaba and K. Aghadi and H. Agilla and B. Ahmed and E.-Z. Ahmed and A.-J. Ahmed and M. Ahmed and R. Ahossi and S.A. Aji and S. Akanyun and I. Akhideno and M. Akhter and O.A. Akinyemi and M. Akkari and J. Akodjenou and A.L. Samateh and {al Shams}, E.S. and O.T. Alagbe-Briggs and E.A. Alakkari and R.B. Alalem and M. Alashhab and O.I. Alatise and A. Alatresh and {Alayeb Alayeb}, M.S.I. and B.A. Albakosh and F. Albert and A.N.J.D. Alberts and A.D. Aldarrat and A. Alfari and A. Alfetore and M. Algbali and A. Algddar and H.A. Algedar and I.A. Alghafoud and A. Alghazali and M. Alhajj and {Alhendery Alhendery}, A. and F.F.H. Alhoty and A. Ali and Y.A. Ali and A. Ali and B.S. Alioune and M.A. Alkassem and M.A. Alkchr and T.S. Alkesa and A. Alkilani and {Alkobty Alkobty}, F. and T. Allaye and S.B.M. Alleesaib and A. Alli and K. Allopi and N.L. Allorto and A. Almajbery and R. Almesmary and S.H.A. Almisslati and F. Almoraid and H. Alobeidi and M.A. Alomami and C.S. Alphonsus and O.A. Alqawi and A.A. Alraheem and S.A. Alsabri and A. Alsayed and B. Alsellabi and M. Al-Serksi and M.S.A. Alshareef and A.A. Altagazi and J.S. Aluvale and H.W. Alwahedi and E.A. Alzahra and M.A. Alzarouk and K. Al-Zubaidy and M. 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Njenga and M.N. Njenga and M. Njoroge and S. Njoroge and W. Njuguna and P.N. Njuki and T. Nkesha and T.N. Nkuebe and N.P. Nkuliyingoma and M. Nkunjana and E. Nkwabi and R.N. Nkwine and C. Nnaji and I. Notoane and S. Nsalamba and L.M. Ntlhe and C. Ntoto and B. Ntueba and M.T. Nyassi and Z. Nyatela-Akinrinmade and H.O. Nyawanda and N.N. Nyokabi and V.N. Nziene and S. Obadiah and O.J.P. Ochieng and P.K. Odia and O.E.O. Oduor and E.O. Ogboli-Nwasor and S.W.O. Ogendo and O. Ogunbode and T.O. Ogundiran and O. Ogutu and R.W. Ojewola and M. Ojujo and D.O. Ojuka and O.S. Okelo and S. Okiya and N. Okonu and P.R. Olang and A.O. Omigbodun and S. Omoding and J. Omoshoro-Jones and R. Onyango and A. Onyegbule and O. Orjiako and M.O. Osazuwa and K. Oscar and B.B. Osinaike and A.O. Osinowo and O.M. Othin and F.F.H. Otman and J. Otokwala and F. Ouanes and O. Oumar and A.O. Ousseini and S. Padayachee and S.M. Pahlana and J. Pansegrouw and F.P. Paruk and M.B. Patel and U. Patel and A.P. Patience and R.M. Pearse and J.D. Pembe and G.N. Pengemale and N. Perez and {Aguilera Perez}, M.F. and A.M. Peter and M. Phaff and R.M. Pheeha and B.H. Pienaar and V. Pillay and K.A. Pilusa and M.P. Pochana and O. Polishchuk and O.S. Porrill and E.F. Post and A. Prosper and M. Pupyshev and A. Rabemazava and M.S. Rabiou and L. Rademan and M. Rademeyer and R.A.R. Raherison and F.R. Rajah and M.S.R. Rajcoomar and Z. Rakhda and A.H.R. Rakotoarijaona and A.H.N. Rakotoarisoa and R.R. Rakotoarison and R.R. Rakotoarison and L. Ramadan and M.L.R. Ramananasoa and M. Rambau and T.P.R. Ramchurn and H.E. Ramilson and R.J. Ramjee and H. Ramnarain and R. Ramos and T.J. Rampai and S.R. Ramphal and T. Ramsamy and R. Ramuntshi and R. Randolph and D.M.A. Randriambololona and W.A.P. Ras and R.A.F. Rasolondraibe and J.D.L.C. Rasolonjatovo and R.M. Rautenbach and S. Ray and S.R. Rayne and F.A.R. Razanakoto and S.R. Reddy and A.R. Reed and J.R. Rian and F.R. Rija and B. Rink and A.T. Robelie and C.A. Roberts and A.G.L. Rocher and S. Rocher and R.N. Rodseth and I. Rois and W. Rois and S. Rokhsi and J. Roos and N.F. Rorke and H. Roura and F.J. Rousseau and N. Rousseau and L. Royas and D. Roytowski and D. Rungan and S.S.R. Rwehumbiza and B.B. Ryabchiy and V. Ryndine and C.R. Saaiman and H.K. Sabwa and S. Sadat and S.S. Saed and E. Salaheddin and H. Salaou and M. Saleh and H.M. Salisu-Kabara and {Doles Sama}, H. and A.L. Samateh and W. Sam-Awortwi and N. Samuel and D.K. Sanduku and C.M. Sani and L.N. Sanyang and H.N. Sarah and A. Sarkin-Pawa and R. Sathiram and T. Saurombe and H. Schutte and M.P. Sebei and M.D. Sedekounou and M.P. Segooa and E.M. Semenya and B.O. Semo and C.S. Sendagire and S.A. Senoga and F.S. Senusi and T. Serdyn and M.D. Seshibe and G.B. Shah and R. Shamamba and C.S. Shambare and T.N. Shangase and S.H. Shanin and I.E. Shefren and A.A. Sheshe and O.B. Shittu and A.S. Shkirban and T. Sholadoye and A. Shubba and N. Sigcu and S.E. Sihope and D.S. Sikazwe and B.S. Sikombe and {Simaga Abdoul}, K. and W.A.G. Simo and K. Singata and A.S. Singh and S. Singh and U. Singh and V. Sinoamadi and N. Sipuka and N.L.M. Sithole and S. Sitima and D.L. Skinner and G.C. Skinner and O.I. Smith and C.A.G. Smits and M.S.I. Sofia and G. Sogoba and A. Sohoub and S.S. Sookun and O. Sosinska and R. Souhe and G. Souley and T. Souleymane and J.M. Spicer and S. Spijkerman and H. Steinhaus and A. Steyn and G. Steyn and H.C. Steyn and H.L. Stoltenkamp and S. Stroyer and A. Swaleh and E. Swayeb and A.J. Szpytko and N.A. Taiwo and A. Tarhuni and D. Tarloff and B. Tchaou and C. Tchegnonsi and M. Tchoupa and M.O. Teeka and B. Thakoor and M.M. Theunissen and B.P. Thomas and M.B. Thomas and A. Thotharam and O. Tobiko and A.M. Torborg and S.M. Tshisekedi and S.K. Tshisola and R. Tshitangano and F. Tshivhula and H.T. Tshuma and J. Tumukunde and M. Tun and I.A. Udo and D.I. Uhuebor and K.U. Umeh and A.O. Usenbo and J.D. Uwiteyimbabazi and {Van der Merwe}, D.J. and {van der Merwe}, F.H. and {van der Walt}, J.E. and {van Dyk}, D. and {Van Dyk}, J.G. and {van Niekerk}, J.J.S. and {van Wyk}, S. and {van Zyl}, H.A. and B. Veerasamy and P.J. Venter and A.J. Vermeulen and R. Villarreal and J. Visser and L. Visser and M. Voigt and {von Rahden}, R.P. and A. Wafa and A. Wafula and P.K. Wambugu and P. Waryoba and E.N. Waweru and M. Weideman and R.D. Wise and E.E. Wynne and A.I. Yahya and A.A. Yahya and R. Yahya and Y. Yakubu and J.J. Yanga and Y.M. Yangazov and O. Yousef and G. Yousef and C. Youssouf and A.A. Yunus and A.S. Yusuf and A.Z. Zeiton and H.Z. Zentuti and H. Zepharine and A.B. Zerihun and S. Zhou and A. Zidan and {Zimogo Zi{\'e}}, S. and C.Z. Zinyemba and A. Zo and L. Zomahoun and N.Z. Zoobei and E. Zoumenou and N.Z. Zubia",
note = "ASOS was funded by a self-initiated Medical Research Council of South Africa grant awarded to B.M.B.",
year = "2018",
month = "12",
doi = "10.1016/j.bja.2018.08.005",
language = "English",
volume = "121",
pages = "1357--1363",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "ELSEVIER APPL SCI PUBL LTD",
number = "6",

}

TY - JOUR

T1 - The ASOS Surgical Risk Calculator

T2 - development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

AU - Kluyts, H.-L.

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AU - Munlemvo, D.M.

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AU - Dodiyi-Manuel, A.

AU - Dokolwana, B.A.

AU - Domoyyeri, D.P.

AU - Drummond, L.W.

AU - du Plessis, D.E.

AU - du Plessis, W.M.

AU - du Preez, L.J.

AU - Dube, K.

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AU - Dullab, K.D.

AU - Duvenhage, R.

AU - Echem, R.C.

AU - Edaigbini, S.A.

AU - Egote, A.K.

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AU - Elfaghi, I.E.

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AU - Elfiky, M.

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AU - Elghandouri, M.G.

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AU - Elghobashy, A.M.

AU - Elharati, F.T.

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AU - Ellis, S.

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AU - Fanjandrainy, R.F.

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AU - Forget, P.

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AU - Gangaly, D.

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AU - Gaya, S.S.D.

AU - Gbéhadé, O.

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N1 - ASOS was funded by a self-initiated Medical Research Council of South Africa grant awarded to B.M.B.

PY - 2018/12

Y1 - 2018/12

N2 - BackgroundThe African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.MethodsASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.ResultsThe model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.ConclusionsThis simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.

AB - BackgroundThe African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.MethodsASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.ResultsThe model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.ConclusionsThis simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.

KW - mortality

KW - preoperative

KW - risk assessment

KW - risk stratification

KW - surgery

UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-85053397457&partnerID=MN8TOARS

U2 - 10.1016/j.bja.2018.08.005

DO - 10.1016/j.bja.2018.08.005

M3 - Article

VL - 121

SP - 1357

EP - 1363

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 6

ER -