Overview
A Cluster Randomized Trial to Determine Whether Increased Postoperative Surveillance of Adult African Surgical Patients Reduces Postoperative Mortality.
Sponser
Non Funded study
Principal Investigator
Abstract
The Non-cardiac surgical population represents a major global public health burden with approximately 234 million major surgical procedures performed worldwide annually.1 In unselected non-cardiac surgical patients, reports of early postoperative mortality vary between 2-4% with an annual global mortality of 5-10 million patients.2,3 The Lancet Commission on Global surgery was established to define safe surgery and develop strategies to ensure the adequate provision of safe surgery. Surgery is a cost effective intervention even in low to middle income countries and as such it is considered a core component of health.4,5,6 Recently the African surgical Outcomes Study (ASOS) demonstrated, that despite a patient low risk profile and low complication rates, patients in Africa were twice as likely to die following surgery when compared to the global average. ASOS provides the most comprehensive data on surgical Outcomes in Africa, comprising 25 countries (including Kenya) 247 hospitals data from over 11,000 patients (Kenya had 322 Patients). Importantly, 95% of the deaths in ASOS occurred in the postoperative period, suggesting that many lives could be saved by effective surveillance for physiological deterioration amongst the patients who developed complications. In ASOS, the median number of combined anaesthesia, surgical and obstetric specialists was 0.7 per 100,000 population which is well below the recommended global minimum point of 20-40 specialists per 100,000 population necessary to significantly decrease surgical mortality.8
It is likely that a major contributor to the high mortality in ASOS was ‘failure to rescue’ partly due to an inadequacy of sufficient human resources necessary to identify post-operative surgical patients at risk. Part of the solution to improving surgical outcomes in Africa is to identify the high risk surgical patient prior to further physiological deterioration.
The objective of this trial is to assess whether increased post-operative surveillance of surgical patients at risk of postoperative morbidity or mortality is associated with improved survival.
