Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study
Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study
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DOI：
10.1016/s0140-6736(18)30001-1
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发表时间：
2018-04-21
期刊：
影响因子：
168.9
通讯作者：
Pearse, Rupert M.
中科院分区：
文献类型：
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作者：
Biccard, Bruce M.;Madiba, Thandinkosi E.;Pearse, Rupert M.
在非洲国家，需要增加手术治疗的机会，但围手术期并发症是全球卫生保健的主要负担。有几个研究描述在Africa.Methods手术结果，我们做了一个为期7天，国际，前瞻性，观察性队列研究的患者年龄在18岁及以上的任何住院手术在25个国家在非洲（非洲手术结果研究）。我们的目标是使用便利抽样调查招募尽可能多的医院，并要求每个国家至少有10家医院（或如果少于10家医院，则为一半的外科中心）的数据，以及每个研究中心至少90%的合格患者的数据。每个国家在2016年2月至5月期间选择一个招聘周。主要结局为院内术后并发症，根据预先确定的标准进行评估，并分为轻度、中度或重度。数据以中位数（IQR）、平均值（SD）或n（%）表示，并使用t检验进行比较。这项研究在南非国家健康研究数据库（KZ_2015RP7_22）和ClinicalTrials.gov（NCT 03044899）上注册。结果我们在国家队列周期间从247家医院招募了11422名患者（中位数29 [IQR 10-70]）。医院为810 000人（IQR 200 000-2 000 000）提供服务，每100 000人中有0.7（0.2-1.9）名专科外科医生、产科医生和麻醉师。医院每年每10万人中平均进行212例（IQR 65-578）外科手术。患者更年轻（平均年龄38.5岁[SD 16.1]），风险特征（美国麻醉医师学会中位数评分1 [IQR 1-2]）低于高收入国家报告的风险特征。1253例（11%）患者感染了HIV，6504例（57%）手术是紧急或急诊手术，最常见的手术是剖腹产（3792例，33%）。10 885例患者中有1977例发生术后并发症（18.2%，95% CI 17.4-18.9]）。11193例患者中239例（2.1%）死亡，225例（94.1%）在手术当天死亡。感染是最常见的并发症（1156 [10.2%]的10 970例患者），其中112（9.7%）dead.Interpretation尽管低风险的配置文件和术后并发症少，在非洲的患者手术后死亡的可能性是两倍，与全球平均术后死亡。因此，在采取措施增加非洲获得外科治疗的机会的同时，还应加强对出现术后并发症的病人生理状况恶化的监测，并提供实现这一目标所需的资源。
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.