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.
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).
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.
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.
Medical Research Council of South Africa.
Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes.
A ...7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899.
Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 3·8% of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 95% CI 1·46–13·65), and perioperative severe obstetric haemorrhage (5·87 1·99–17·34) or anaesthesia complications (11·47 (1·20–109·20). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0).
Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa.
Medical Research Council of South Africa.
Aim: To evaluate the cosmetic appearance of herniotomy wound scars
closed using either the tissue glue or subcuticular suturing technique.
Materials and Methods: Prospective randomised control study;
...randomisation into tissue glue and suturing groups. Ethical clearance
obtained. Cosmetic outcome were based on visual analogue scale by
parents and Hollander wound evaluation scale by a Plastic Surgeon
blinded to the wound closure method. Results: Fifty one wounds were
evaluated, 26 in the tissue glue group and 25 in the suturing group.
Parents′ evaluation using Visual Analogue scale (VAS) showed that
in the suturing group, 17 parents (68%) gave a VAS of 8cm while six
parents (24%) gave a score of 7cm. Two parents (8%) gave a score of
9cm. In the tissue glue group, 22 parents (84.6%) scored the scar of
their children as 8 or 9cm on the VAS while four parents (15.4%) gave a
score of 7cm. The median VAS was 8cm for both groups with a range of 7
to 9cm. The Chi- square test showed that the parents preferred tissue
glue compared with subcuticular suturing (X2 = 7.90, P < 0.05). The
Hollander Wound Evaluation Scale (HWES) used by Plastic Surgeon showed
21 herniotomy wounds (84%) had a score of 6 in the suturing group while
four wounds (16%) had a score of 5. In the tissue glue group, 19 wounds
(73%) had a score of 6, six wounds (23.1%) had a score of 5 and a
patient (3.8%) had a score of 4. The median score is 6 for both groups.
There was no statistically significant difference between both groups
(X 2 = 1.481, P = 0.393). Conclusion: This study has shown that the
cosmetic outcome of wound closure using the tissue glue technique and
subcuticular suturing technique are similar.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Introduction: Circumcision is the surgical removal of the skin covering the glans penis (prepuce). Circumcision is performed worldwide, among many tribe and races. It is the commonest surgical ...procedure done in males. It is perform by both trained and non-trained medical personal. Aims and Objective: To compare the outcome of circumcision done by dorsal slit and plastibell methods. Methods and Materials: A prospective study was done over 1 year period. A structured questionnaire was used to collect data. It was a cross-sectional analytical study with sample size of 120 patients divided in to 2 study groups. Group A had dorsal slit while group B had plastibell type of circumcision. Results: The age of circumcision varies between 7days to 10 years. The average duration of the procedure was 12minutes for dorsal slit and 7 minutes, with estimated blood loss of 7mls and 4mls in the two methods. The most common complications observed in our study are surgical site infection, post operative haemorrhage, and delayed separation of the ring. While surgical site infection is more in plastibell method, post operative haemorrhage was found to be commoner in dorsal slit method. Conclusion: Our study showed that plastibell has an obvious advantage of shorter time of procedure, lower risk of post operative bleeding compared to the conventional dorsal slit method of circumcision.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
5.
Two Cases of Neonatal Gastric Perforation Lb, Abdullahi; Am, Mohammad; Ljc, Anyanwu ...
Journal of neonatal surgery,
07/2015, Letnik:
4, Številka:
3
Journal Article
PDF
