Outcomes after surgery for children in Africa (ASOS-Paeds): a 14-day prospective observational cohort study
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 hospital...
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| Veröffentlicht in: | The Lancet (British edition) Jg. 403; H. 10435; S. 1482 - 1492 |
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| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
England
Elsevier Ltd
13.04.2024
Elsevier Limited |
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| ISSN: | 0140-6736, 1474-547X, 1474-547X |
| Online-Zugang: | Volltext |
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| Abstract | 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.
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.
We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals).
Outcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four-fold higher (18% vs 4·4–14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 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.
Jan Pretorius Research Fund of the South African Society of Anaesthesiologists and Association of Anesthesiologists of Uganda. |
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| AbstractList | 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.
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.
We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals).
Outcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four-fold higher (18% vs 4·4–14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 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.
Jan Pretorius Research Fund of the South African Society of Anaesthesiologists and Association of Anesthesiologists of Uganda. 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.BACKGROUNDSafe 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.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.METHODSThis 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.We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals).FINDINGSWe recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals).Outcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four-fold higher (18% vs 4·4-14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 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.INTERPRETATIONOutcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four-fold higher (18% vs 4·4-14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 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.Jan Pretorius Research Fund of the South African Society of Anaesthesiologists and Association of Anesthesiologists of Uganda.FUNDINGJan Pretorius Research Fund of the South African Society of Anaesthesiologists and Association of Anesthesiologists of Uganda. Summary 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 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] 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 4·4–14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 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. Funding Jan Pretorius Research Fund of the South African Society of Anaesthesiologists and Association of Anesthesiologists of Uganda. |
| Author | Fidieley, Melody Alhaddad, Hayfa Faraj Woldegiorgis, Abel Elhassan, Mohamed Fikadu Keneni, Dame Ellebedy, Mohamed Asman, Wilfred GAYE, Ibrahima Mashaya, Sonela Gueye, Khadim Rassoul Zulu, Nonhlanhla Ali, Asma Maharaj, Sanvir Ehimhantie, Martins Soula, Enas Ugalahi, Mary YUSUF, STEPHEN Farinyaro, Aliyu Umar Okedare, Amos Oyedepo, Olanrewaju Human, Thys Asasira, Lausa Musa, Mosaab Abdelhafiz Ebrahim Achouri, Djelloul Tientcheu Fabrice, Tim Edena, Morrison E. Barhouma, Yehia Emad Motseoile, Toni Geldenhuys, Lieze Martin, Mogammad Ebrahim Afedo, Wisdom WILLIAMS, Omolara Abdoulaye, Touré Temesgen, Fissha Ahmed, Linda Rajah, Chantal Kotey, Emily Gebremichael Ganta, Ashagre Kassem, Ossama Assalhi, Mohamed Rabiu, Ayuba Mungur, Luckshmanraj Ben Ashur, Abir ADAMU, MUHAMMAD Oyegbola, Christianah Lebereki, Simon Salem, Osama Baddoo, Daniel Frankish, Leanne Panday, Juniata Alharam, Abtisam Dairam, Jenitha Umar, Aminu Muhammed Ademuyiwa, Adesoji O Fofana, Naby Grayson, Britney L. Mogotsi, Kena Agbonrofo, Peter Balogun, James Drissi, Hajer Otchere, Kofi Eltaye |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38527482$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1007_s00383_024_05718_9 crossref_primary_10_1136_bmjopen_2024_086350 crossref_primary_10_1001_jamasurg_2025_1430 crossref_primary_10_1016_S0140_6736_24_02846_0 crossref_primary_10_1016_S0140_6736_25_00985_7 crossref_primary_10_36303_SAJAA_3226 crossref_primary_10_1111_pan_14943 |
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| ContentType | Journal Article |
| Contributor | Ki, Kélan Bertille Abdus-Salam, Rukiyat Ramkalawan, Kushal Nabukenya, Mary T Osinaike, Babatunde Babasola Abd Elazeem Mohammed, Hossam Aldein Samir Shalongo, Sarah Pearse, Rupert Abdelgadir, Waffa Taye, Desalegn Bekele Derbew, Miliard Kechiche, Nahla Randriamizao, Harifetra Mamy Richard Kluyts, Hyla Abdelmohsen, Sarah Magdy Ali Daoud, Hassan Dahir, Shukri Abdelkarim, Maha Abdelkader Osman, Mohamed Hardy, Anneli Fanny, Marvin Nyarko, Mame Yaa Adobea Omar, Mohamed Abdinor Abdoulaye, Touré Duvenage, Hanel Bouaoud, Souad Abdullahi, Lawal Barau Abdulsalam, Khalifa Ibrahim Abdelaleem, Ibrahim Abdelmonaem Abu, Mohammed Torborg, Alexandra Abdullahi, Muzammil Aboelghait, Aml Ali Fawzy, Maher Ademuyiwa, Adesoji O Abol Oyoun, Nariman Abdulwahed, Eman Aboubekr, Boumediene Chaibou, Maman Sani Abdulghaffar, Yunus A Abdullah, Fatimaalzahraa Samateh, Ahmadou Lamin Abdalkarim, Batool Abdulai, Samira Thomson, Emma Abdalla, Abubaker Ndikontar, Raymond Meyer, Heidi Fadalla, Tarig Smalle, Isaac Abdelwahed, Aya Elsayed Traore, Mamadou Mour Mohamed, Mubarak Ra |
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| Copyright | 2024 Elsevier Ltd Copyright © 2024 Elsevier Ltd. All rights reserved. 2024. Elsevier Ltd |
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| References | Biccard, Madiba, Kluyts (bib2) 2018; 391 (bib10) 2021; 6 Meara, Leather, Hagander (bib1) 2015; 386 Gajewski, Pittalis, Borgstein (bib26) 2023; 11 Alzubaidi, Karabayir, Akbilgic, Langham (bib18) 2022; 275 von Elm, Altman, Egger, Pocock, Gøtzsche, Vandenbroucke (bib12) 2007; 4 Galal (bib3) 2023 Tarekegn, Seyoum, Abebe, Terefe (bib6) 2021; 67 Torborg, Cronje, Thomas (bib8) 2019; 122 Thompson, Jones, Pardy (bib17) 2020; 55 Talabi, Ojo, Aaron, Sowande, Faponle, Adejuyigbe (bib5) 2021; 4 Pearse, Moreno, Bauer (bib11) 2012; 380 Habre, Disma, Virag (bib20) 2017; 5 Kannampallil, Lew, Pfeifer, Sharma, Abraham (bib21) 2021; 30 Tyson, Msiska, Kiser (bib25) 2014; 12 Seyi-Olajide, Anderson, Kaseje (bib28) 2021; 37 Peduzzi, Concato, Kemper, Holford, Feinstein (bib14) 1996; 49 Portuondo, Shah, Raval (bib19) 2022; 276 Valencia, Staffa, Faraoni, DiNardo, Nasr (bib22) 2019; 129 Weinberg, Huang, Jiang (bib16) 2011; 212 Meyer, Thomas, Wilson, de Kock (bib7) 2017; 27 Newton, Hurt, McEvoy (bib9) 2020; 132 Hadler, Chawla, Stewart, McCunn, Kushner (bib27) 2016; 40 Debas, Donkor, Gawande, Jamison, Kruk, Mock (bib13) 2015 Leyland, Groenewegen (bib15) 2020 Ajao, Adeniran (bib23) 2022; 19 Negash, Tigabe, Kiflu, Derbew (bib24) 2021; 31 Biccard, du Toit, Lesosky (bib4) 2021; 9 Pearse (10.1016/S0140-6736(24)00103-X_bib11) 2012; 380 Meara (10.1016/S0140-6736(24)00103-X_bib1) 2015; 386 Talabi (10.1016/S0140-6736(24)00103-X_bib5) 2021; 4 Leyland (10.1016/S0140-6736(24)00103-X_bib15) 2020 Ajao (10.1016/S0140-6736(24)00103-X_bib23) 2022; 19 Gajewski (10.1016/S0140-6736(24)00103-X_bib26) 2023; 11 Hadler (10.1016/S0140-6736(24)00103-X_bib27) 2016; 40 Newton (10.1016/S0140-6736(24)00103-X_bib9) 2020; 132 (10.1016/S0140-6736(24)00103-X_bib10) 2021; 6 Torborg (10.1016/S0140-6736(24)00103-X_bib8) 2019; 122 Negash (10.1016/S0140-6736(24)00103-X_bib24) 2021; 31 Debas (10.1016/S0140-6736(24)00103-X_bib13) 2015 von Elm (10.1016/S0140-6736(24)00103-X_bib12) 2007; 4 Kannampallil (10.1016/S0140-6736(24)00103-X_bib21) 2021; 30 Alzubaidi (10.1016/S0140-6736(24)00103-X_bib18) 2022; 275 Seyi-Olajide (10.1016/S0140-6736(24)00103-X_bib28) 2021; 37 Biccard (10.1016/S0140-6736(24)00103-X_bib2) 2018; 391 Habre (10.1016/S0140-6736(24)00103-X_bib20) 2017; 5 Tyson (10.1016/S0140-6736(24)00103-X_bib25) 2014; 12 Galal (10.1016/S0140-6736(24)00103-X_bib3) Biccard (10.1016/S0140-6736(24)00103-X_bib4) 2021; 9 Weinberg (10.1016/S0140-6736(24)00103-X_bib16) 2011; 212 Thompson (10.1016/S0140-6736(24)00103-X_bib17) 2020; 55 Valencia (10.1016/S0140-6736(24)00103-X_bib22) 2019; 129 Portuondo (10.1016/S0140-6736(24)00103-X_bib19) 2022; 276 Meyer (10.1016/S0140-6736(24)00103-X_bib7) 2017; 27 Tarekegn (10.1016/S0140-6736(24)00103-X_bib6) 2021; 67 Peduzzi (10.1016/S0140-6736(24)00103-X_bib14) 1996; 49 38527481 - Lancet. 2024 Apr 13;403(10435):1425-1427. doi: 10.1016/S0140-6736(24)00320-9. |
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| SubjectTerms | Adults Anesthesia Child Children Cohort analysis Cohort Studies Complications Consent Elective Surgical Procedures - adverse effects Epidemiology Fatalities Female General anesthesia Health care policy High income Hospitals Humans Industrialized nations Infant Infant, Newborn Male Meta-analysis Mortality Neonates Observational studies Patients Pediatrics Perioperative care Postoperative Postoperative Complications - etiology Prospective Studies Public health Research ethics Surgery Surgical outcomes Uganda |
| Title | Outcomes after surgery for children in Africa (ASOS-Paeds): a 14-day prospective observational cohort study |
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