Gates funded study probes post-operative deaths in Africa
SURGICAL patients in Africa are twice as likely to die in hospital after surgery when compared with the global average, a study on post-operative deaths in Africa has found.
The University of Cape Town yesterday said the deaths were due to failure to recognise or respond to common post-operative complications.
The study, published in the Lancet Global Health journal, details the African Surgical Outcomes-2 (Asos-2) trial that tried to address the problem of post-operative deaths in Africa.
It was funded by the Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists.
During the trial, patients at a greater risk of death were identified and the limited available care was redirected to them.
Investigators randomised hospitals in clusters across the continent to provide either enhanced post-operative surveillance to high-risk patients or standard care.
UCT said the enhanced surveillance interventions included admitting a patient to the higher-care ward and increasing the frequency of post-operative observations from nurses. The patient was assigned a bed in view of the nursing station, family members were allowed to stay in the ward, and a post-operative surveillance guide was placed at the bedside.
Hospitals numbering 332 from 28 African countries participated in the trial between May 2019 and July last year. The average age of the patients was 37, 69.4% of whom were women.
In the trial, 160 hospitals with 13 275 patients were placed in the enhanced post-operative surveillance arm of the trial, while 172 hospitals with 15 617 patients were in the standard care arm of the trial. It found that although the intervention offered greater insight into what was required to implement interventions to decrease post-operative deaths in resource-limited environments, it was not associated with improved in-hospital survival.
The lead investigator, Professor Bruce Biccard from the Department of Anaesthesia and Perioperative Medicine at Groote Schuur Hospital and UCT, said the intervention did not improve the outcome. He said that although the intervention was designed and piloted before the trial to improve post-operative surveillance, the implementation of increased post-operative surveillance was not as successful as was hoped.
“Furthermore, even when patient deterioration was correctly identified, we don’t know whether local teams had the means to escalate care appropriately to improve outcome,” he said.
Biccard said a “generic fix” for surgical mortality in Africa did not work in this trial, but the African Perioperative Research Group had demonstrated that it had the capacity to do perioperative research at a scale in Africa.
“Future projects will have an increased focus on co-designing interventions with the local teams and the use of proven strategies to ensure successful implementation,” he said.
Professor Landon Myer from UCT said: “The scale of this trial within Africa – enrolling at hundreds of hospitals across the continent – demonstrates the kinds of internationally significant public health research that is possible with the right leadership, commitment, energy and vision.” |