• T E Madiba and B Biccard.
• Perioperative Research Group, Department of Surgery, University Of KwaZulu-Natal.
• S Afr J Surg. 2017 Sep 1; 55 (3): 75.

BackgroundPostoperative mortality represents a major global health burden. There is little internationally comparable data from Africa of outcomes following surgery.MethodSeven day, national, multicentre, prospective, observational cohort study of patients ≥18 years of age undergoing in-patient surgery in Africa. The primary outcome was in-hospital postoperative surgical complications. Secondary outcomes included; i) in-hospital mortality, ii) and the relationship between postoperative complications and postoperative mortality, and the risk factors independently associated with in-hospital mortality and postoperative complications.Results11422 patients participated from 25 countries in Africa. In hospital complications following surgery were observed in 1977/10885 (18.1%, 95% CI 17.4-18.9) patients, and mortality was 239/11193 (2.1%, 95% CI 1.8-2.4). The median duration of hospital stay was 3 (IQR 2-5) days which was significantly increased to 6 (IQR 4-13) days (p<0.001) following a complication. The postoperative admission in intensive care unit was 511/10991 (4.6%, 95% CI 4.3-5.0). When compared to the International Surgical Outcomes Study (ISOS), patients in Africa were twice as likely to die following surgery and following a surgical complication (p<0.001).ConclusionAlthough, surgical patients in Africa have a lower risk profile than high-income countries, there is a significantly increased mortality following a surgical complication in Africa.

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