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Outcomes after surgery for children in Africa (ASOS-Paeds): a 14-day prospective observational cohort study
Journal article   Peer reviewed

Outcomes after surgery for children in Africa (ASOS-Paeds): a 14-day prospective observational cohort study

Alexandra Torborg, Heidi Meyer, Mahmoud El Fiky, Maher Fawzy, Muhammed Elhadi, Adesoji O. Ademuyiwa, Babatunde Babasola Osinaike, Adam Hewitt-Smith, Mary T. Nabukenya, Ronald Bisegerwa, …
The Lancet (British edition), Vol.403(10435), pp.1482-1492
04/13/2024
DOI: 10.1016/S0140-6736(24)00103-X
PMID: 38527482
url
https://qmro.qmul.ac.uk/xmlui/handle/123456789/98806View
Open Access

Abstract

Background Safe anaesthesia and surgery are a public health imperative. There are few data describing outcomes for children undergoing anaesthesia and surgery in Africa. We aimed to get robust epidemiological data to describe patient care and outcomes for children undergoing anaesthesia and surgery in hospitals in Africa. Methods This study was a 14 -day, international, prospective, observational cohort study of children (aged <18 years) undergoing surgery in Africa. We recruited as many hospitals as possible across all levels of care (first, second, and third) providing surgical treatment. Each hospital recruited all eligible children for a 14 -day period commencing on the date chosen by each participating hospital within the study recruitment period from Jan 15 to Dec 23, 2022. Data were collected prospectively for consecutive patients on paper case record forms. The primary outcome was in hospital postoperative complications within 30 days of surgery and the secondary outcome was in -hospital mortality within 30 days after surgery. We also collected hospital -level data describing equipment, facilities, and protocols available. This study is registered with ClinicalTrials.gov, NCT05061407. Findings We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6<middle dot>1 (SD 4<middle dot>9) years, with 5675 (66<middle dot>0%) of 8600 children being male. Most children (6110 [71<middle dot>2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61<middle dot>9%] of 8604 patients). Postoperative complications occurred in 1532 (18<middle dot>0%) of 8515 children, predominated by infections (971 [11<middle dot>4%] of 8538 children). Deaths occurred in 199 (2<middle dot>3%) of 8596 patients, 169 (84<middle dot>9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10<middle dot>8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54<middle dot>3%] of 223 hospitals), infants (147 [65<middle dot>9%] of 223 hospitals), and children younger than 6 years (188 [84<middle dot>3%] of 223 hospitals). Interpretation Outcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four -fold higher (18% vs 4<middle dot>4-14%) and mortality rates 11 -fold higher than high -income countries in a crude, unadjusted comparison (23<middle dot>15 deaths vs 2<middle dot>18 deaths per 1000 children). To improve surgical outcomes for children in Africa, we need health system strengthening, provision of safe environments for anaesthesia and surgery, and strategies to address the high rate of failure to rescue. Copyright (c) 2024 Elsevier Ltd. All rights reserved.
 General & Internal Medicine Life Sciences & Biomedicine Medicine, General & Internal Science & Technology

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