Nigerian surgical outcomes - Report of a 7-day prospective cohort study and external validation of the African surgical outcomes study surgical risk calculator.

Autor: Osinaike B; Department of Anaesthesia, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria. Electronic address: drosinaike@yahoo.co.uk., Ayandipo O; Department of Surgery, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria., Onyeka T; Department of Anaesthesia, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria., Alagbe-Briggs O; Department of Anaesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria., Mohammed A; Department of Anaesthesia, Aminu Kano University Teaching Hospital, Kano, Kano State, Nigeria., Oyedepo O; Department of Anaesthesia, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria., Nuhu A; Department of Anaesthesia, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria., Asudo F; Department of Anaesthesia, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria., Akanmu O; Department of Anaesthesia, University of Lagos Teaching Hospital, Lagos, Lagos State, Nigeria., Nwokorie C; Department of Anaesthesia, Federal Medical Centre, Umahia, Abia State, Nigeria., Mohammed A; Department of Anaesthesia, Federal Medical Centre, Yola, Adamawa State, Nigeria., Edubio M; Department of Anaesthesia, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria., Izuora K; Department of Anaesthesia, Nnamdi Azikwe University Teaching Hospital, Nnewi, Anambra State, Nigeria., Mohammed R; Department of Anaesthesia, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Bauchi State, Nigeria., Nweze O; Department of Anaesthesia, Federal Medical Centre, Yenegoa, Bayelsa State, Nigeria., Efu M; Department of Anaesthesia, Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria., Eguma S; Department of Anaesthesia, University of Calabar Teaching Hospital, Calabar, Cross-River State, Nigeria., Jasper A; Department of Anaesthesia, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria., Ewah R; Department of Anaesthesia, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria., Akhideno I; Department of Anaesthesia, Irrua Specialist Hospital, Irrua, Edo State, Nigeria., Nnaji C; Department of Anaesthesia, Federal Medical Centre, Owerri, Imo State, Nigeria., Ado S; Department of Anaesthesia, Rasheed Sekoni Teaching Hospital, Dutse, Jigawa State, Nigeria., Ogboli-Nwasor E; Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria., Atiku M; Department of Anaesthesia, Aminu Kano University Teaching Hospital, Kano, Kano State, Nigeria., Salisu I; Department of Anaesthesia, Federal Medical Centre, Katsina, Katsina State, Nigeria., Adinoyi Y; Department of Anaesthesia, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria., Agu E; Department of Anaesthesia, Federal Medical Centre, Lokoja, Kogi State, Nigeria., Desalu I; Department of Anaesthesia, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria., Samuel L; Department of Anaesthesia, Federal Medical Centre, Keffi, Nasarawa, Nigeria., Olorode Y; Department of Anaesthesia, Federal Medical Centre, Bida, Niger State, Nigeria., Fatungase O; Department of Anaesthesia, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria., Akinwonmi O; Department of Anaesthesia, Federal Medical Centre, Owo, Ondo State, Nigeria., Faponle F; Department of Anaesthesia, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria., Idowu O; Department of Anaesthesia, UniUniversity College Hospital, Ibadan, Oyo State, Nigeria., Isamade E; Department of Anaesthesia, Jos University Teaching Hospital, Jos, Plateau State, Nigeria., Aliyu A; Department of Anaesthesia, Uthman Dan Fodio University Teaching Hospital, Sokoto, Sokoto State, Nigeria., Buba S; Department of Anaesthesia, Federal Medical Centre, Jalingo, Taraba State, Nigeria., Hamza G; Department of Anaesthesia, Federal Medical Centre, Gusau, Zamfara State, Nigeria., Onajin-Obembe B; Department of Anaesthesia, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria; Department of Anaesthesia, University of Port Harcourt, Port Hartcourt, Rivers State, Nigeria., Amanor-Boadu S; Department of Anaesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria; Department of Anaesthesia, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria.
Jazyk: angličtina
Zdroj: International journal of surgery (London, England) [Int J Surg] 2019 Aug; Vol. 68, pp. 148-156. Date of Electronic Publication: 2019 Jun 19.
DOI: 10.1016/j.ijsu.2019.06.003
Abstrakt: Background: Surgical outcomes study for individual nations remains important because of international differences in patterns of surgical disease. We aimed to contribute to data on post-operative complications, critical care admissions and mortality following elective surgery in Nigeria and also validate the African Surgical Outcomes Study (ASOS) surgical risk calculator in our adult patient cohort.
Materials and Methods: We conducted a 7-day, national prospective observational cohort study in consented consecutive patients undergoing elective surgery with a planned overnight hospital stay following elective surgery during a seven-day study period. The outcome measures were in-hospital postoperative complications, critical care admissions and in-hospital mortality censored at 30 days. Also, we identified variables which significantly contributed to higher ASOS surgical risk score. External validation was performed using area under the receiver operating characteristic curve (ROC) for discrimination assessment and Hosmer-Lemeshow test for calibration.
Results: A total of 1,425 patients from 79 hospitals participated in the study. Postoperative complications occurred in 264(18.5%, 95% CI 16.6-20.6), 20(7.6%) of whom were admitted into the ICU and 16(6.0%) did not survive. Total ICU admission was 57 (4%), with mortality rate of 23.5% following planned admission and overall in-hospital death was 22(1.5%, 95% CI 0.9-2.2). All prognostic factors in the ASOS risk calculator were significantly associated with higher ASOS score and the scoring system showed moderate discrimination (0⋅73, 95% CI 0.62-0.83). Hosmer-Lemeshow χ2 test revealed scale was well calibrated in the validation cohort.
Conclusion: NiSOS validates the findings of ASOS and the ability of the ASOS surgical risk calculator to predict risk of developing severe postoperative complications and mortality. We identified failure-to-rescue as a problem in Nigeria. Furthermore, this study has provided policy makers with benchmarks that can be used to monitor programmes aimed at reducing the morbidity and mortality after elective surgery. We recommend the adoption of the ASOS surgical risk calculator as a tool for risk stratification preoperatively for elective surgery.
(Copyright © 2019 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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