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Non-emergency surgical death rates in Africa are double the global average

Elective surgeries in African countries have a death rate double that of the global average, a new study reveals.

Surgery in Africa File photo Source: Ton Koene/PA Images

THE DEATH RATE for certain surgeries on the African continent are twice those seen on average globally, new research has revealed.

Almost one in five patients in Africa suffer complications after surgery, and 2% of patients die after such operations.

The data is contained in the just-published African Surgical Outcomes Study (ASOS) – a seven-day observational study involving 11,422 patients who underwent surgery in 247 hospitals, in 25 African countries (comprising 14 low-income countries like Burundi and Ethiopia, and 11 middle-income nations such as Algeria, Egypt and Kenya).

The figures, when compared to the global average, are stark, particularly in the case of elective surgeries.

For such non-emergency surgeries, those requesting same displayed a death rate of 1% – twice the global rate of 0.5%.

The study itself claims that its results indicate that “scarce workforce and resources mean surgery is less safe across the region”, and that an obvious action point for such numbers would be to improve “monitoring of patients during and soon after their surgery”.

Of the 11,422 patients studied, one in five developed post-operative complications, with 95% of the deaths seen occurring in the days post-surgery.

Not high-risk

Nor were the patients involved of a high-risk status prior to their operations – 87.3% had “a good physical status and were low-risk for surgery” according to the researchers.

The majority of operations were deemed “urgent or emergent” meanwhile, with caesarean sections (33.3%) easily the most prevalent of the procedures documented.

“Our study reveals the scarce workforce resources available to provide safe surgical treatment. Although increased access to surgery is important, it is essential that these surgical treatments are safe and effective,” said Professor Bruce Biccard of the University of Cape Town, the lead author of the study.

95% of deaths in our study occurred in the post-operative period, suggesting that many lives could be saved by effective monitoring of patients who have developed complications and increasing the resources necessary to achieve this objective.

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“Surgical outcomes will remain poor in Africa until the problem of under-resourcing is addressed,” he added.

The researchers stressed that much of the issues seen could be alleviated by better post-operative monitoring of patients. The issue is, however, one of scant resources, with each hospital included in the study serving an average population of 810,000 people, with an average of 300 beds, four operating rooms, and three critical care beds.

A lack of personnel is also cited as a reason for the worrying trends seen – with just 0.7 specialists serving every 100,000 people in each hospital’s population. In order to reduce mortality, a figure of between 20 and 40 specialists is required per 100,000 patients, according to the researchers.

“Our study highlights the importance of effective perioperative care to achieve better surgical outcomes in Africa,” said Biccard of the study’s findings.

“A continent-wide quality improvement programme might reduce the number of preventable deaths following surgery in Africa,” he added.

The full study can be found here

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