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Rates of surgical deaths and infections at district hospitals in Malawi and Zambia: a prospective multicentre cohort study

OBJECTIVE: This paper reports perioperative mortality and postoperative infection rates of surgical patients who underwent operations at district-level hospitals in Malawi and Zambia, and the associations of these outcomes with patient characteristics based on routinely available data. DESIGN: Prosp...

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Autores principales: Gajewski, Jakub, Zhang, Mengyang, Bijlmakers, Leon, Pittalis, Chiara, Borgstein, Eric, Mwapasa, Gerald, Kachimba, John, Cheelo, Mweene, Waterman, Kristen, Brugha, Ruairi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718480/
http://dx.doi.org/10.1136/bmjopen-2021-049126
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author Gajewski, Jakub
Zhang, Mengyang
Bijlmakers, Leon
Pittalis, Chiara
Borgstein, Eric
Mwapasa, Gerald
Kachimba, John
Cheelo, Mweene
Waterman, Kristen
Brugha, Ruairi
author_facet Gajewski, Jakub
Zhang, Mengyang
Bijlmakers, Leon
Pittalis, Chiara
Borgstein, Eric
Mwapasa, Gerald
Kachimba, John
Cheelo, Mweene
Waterman, Kristen
Brugha, Ruairi
author_sort Gajewski, Jakub
collection PubMed
description OBJECTIVE: This paper reports perioperative mortality and postoperative infection rates of surgical patients who underwent operations at district-level hospitals in Malawi and Zambia, and the associations of these outcomes with patient characteristics based on routinely available data. DESIGN: Prospective cohort study. SETTING: Eight government district hospitals in Malawi and nine mission and government district hospitals in Zambia. OUTCOME MEASURES: Perioperative mortality and postoperative infection were used as primary outcome measures in this study. Logistic regression and penalised maximum likelihood logistic regression were used to examine the factors correlated with surgical outcomes. RESULTS: The average perioperative mortality rates were 0.19% and 0.43% in Malawi and Zambia, respectively. Penalised maximum likelihood logistic regression showed that age (OR=1.046, 95% CI 1.016 to 1.078) and American Society of Anesthesiologists physical status score II (OR=6.658, 95% CI 2.363 to 18.762) were significantly associated with perioperative deaths. General surgery procedures were significantly more likely than obstetrical procedures to result in perioperative deaths (OR=3.821, 95% CI 1.226 to 11.908). The average rates of postoperative infections in Malawi and Zambia were 2.69% and 2.24%, respectively. Age (OR=1.010, 95% CI 1.000 to 1.020) and male sex (OR=0.407, 95% CI 0.260 to 0.637) were significantly associated with postoperative infections. Additional factors, general procedures (OR=2.319, 95% CI 1.397 to 3.850) and trauma-related procedure (OR=5.490, 95% CI 2.632 to 11.449) were significantly associated with infection rates. There was no significant correlation between surgical outcomes and cadre of lead surgeon (a non-physician clinician or doctor). CONCLUSION: Rates of mortality and postoperative infections in this sample of district-level hospitals in Malawi and Zambia were relatively low, with poorer preoperative physical status as the main predictor of both greater postoperative infection and mortality. The study demonstrates that outcomes of major surgical cases do not depend on the cadre (type) of surgeon performing it, and outcomes can be monitored using routine data, at district level in these countries. TRIAL REGISTRATION NUMBER: ISRCTN66099597.
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spelling pubmed-87184802022-01-12 Rates of surgical deaths and infections at district hospitals in Malawi and Zambia: a prospective multicentre cohort study Gajewski, Jakub Zhang, Mengyang Bijlmakers, Leon Pittalis, Chiara Borgstein, Eric Mwapasa, Gerald Kachimba, John Cheelo, Mweene Waterman, Kristen Brugha, Ruairi BMJ Open Surgery OBJECTIVE: This paper reports perioperative mortality and postoperative infection rates of surgical patients who underwent operations at district-level hospitals in Malawi and Zambia, and the associations of these outcomes with patient characteristics based on routinely available data. DESIGN: Prospective cohort study. SETTING: Eight government district hospitals in Malawi and nine mission and government district hospitals in Zambia. OUTCOME MEASURES: Perioperative mortality and postoperative infection were used as primary outcome measures in this study. Logistic regression and penalised maximum likelihood logistic regression were used to examine the factors correlated with surgical outcomes. RESULTS: The average perioperative mortality rates were 0.19% and 0.43% in Malawi and Zambia, respectively. Penalised maximum likelihood logistic regression showed that age (OR=1.046, 95% CI 1.016 to 1.078) and American Society of Anesthesiologists physical status score II (OR=6.658, 95% CI 2.363 to 18.762) were significantly associated with perioperative deaths. General surgery procedures were significantly more likely than obstetrical procedures to result in perioperative deaths (OR=3.821, 95% CI 1.226 to 11.908). The average rates of postoperative infections in Malawi and Zambia were 2.69% and 2.24%, respectively. Age (OR=1.010, 95% CI 1.000 to 1.020) and male sex (OR=0.407, 95% CI 0.260 to 0.637) were significantly associated with postoperative infections. Additional factors, general procedures (OR=2.319, 95% CI 1.397 to 3.850) and trauma-related procedure (OR=5.490, 95% CI 2.632 to 11.449) were significantly associated with infection rates. There was no significant correlation between surgical outcomes and cadre of lead surgeon (a non-physician clinician or doctor). CONCLUSION: Rates of mortality and postoperative infections in this sample of district-level hospitals in Malawi and Zambia were relatively low, with poorer preoperative physical status as the main predictor of both greater postoperative infection and mortality. The study demonstrates that outcomes of major surgical cases do not depend on the cadre (type) of surgeon performing it, and outcomes can be monitored using routine data, at district level in these countries. TRIAL REGISTRATION NUMBER: ISRCTN66099597. BMJ Publishing Group 2021-12-30 /pmc/articles/PMC8718480/ http://dx.doi.org/10.1136/bmjopen-2021-049126 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Surgery
Gajewski, Jakub
Zhang, Mengyang
Bijlmakers, Leon
Pittalis, Chiara
Borgstein, Eric
Mwapasa, Gerald
Kachimba, John
Cheelo, Mweene
Waterman, Kristen
Brugha, Ruairi
Rates of surgical deaths and infections at district hospitals in Malawi and Zambia: a prospective multicentre cohort study
title Rates of surgical deaths and infections at district hospitals in Malawi and Zambia: a prospective multicentre cohort study
title_full Rates of surgical deaths and infections at district hospitals in Malawi and Zambia: a prospective multicentre cohort study
title_fullStr Rates of surgical deaths and infections at district hospitals in Malawi and Zambia: a prospective multicentre cohort study
title_full_unstemmed Rates of surgical deaths and infections at district hospitals in Malawi and Zambia: a prospective multicentre cohort study
title_short Rates of surgical deaths and infections at district hospitals in Malawi and Zambia: a prospective multicentre cohort study
title_sort rates of surgical deaths and infections at district hospitals in malawi and zambia: a prospective multicentre cohort study
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718480/
http://dx.doi.org/10.1136/bmjopen-2021-049126
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