Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 1/2021

Open Access 01-01-2021 | Laparotomy | Surgery in Low and Middle Income Countries

In-Hospital Postoperative Mortality Rates for Selected Procedures in Tanzania’s Lake Zone

Authors: Taylor Wurdeman, Christopher Strader, Shehnaz Alidina, David Barash, Isabelle Citron, Ntuli Kapologwe, Erastus Maina, Fabian Massaga, Adelina Mazhiqi, John G. Meara, Gopal Menon, Cheri Reynolds, Meaghan Sydlowski, John Varallo, Sarah Maongezi, Mpoki Ulisubisya

Published in: World Journal of Surgery | Issue 1/2021

Login to get access

Abstract

Background

Postoperative mortality rate is one of six surgical indicators identified by the Lancet Commission on Global Surgery for monitoring access to high-quality surgical care. The primary aim of this study was to measure the postoperative mortality rate in Tanzania’s Lake Zone to provide a baseline for surgical strengthening efforts. The secondary aim was to measure the effect of Safe Surgery 2020, a multi-component intervention to improve surgical quality, on postoperative mortality after 10 months.

Methods

We prospectively collected data on postoperative mortality from 20 health centers, district hospitals, and regional hospitals in Tanzania’s Lake Zone over two time periods: pre-intervention (February to April 2018) and post-intervention (March to May 2019). We analyzed postoperative mortality rates by procedure type. We used logistic regression to determine the impact of Safe Surgery 2020 on postoperative mortality.

Results

The overall average in-hospital non-obstetric postoperative mortality rate for all surgery procedures was 2.62%. The postoperative mortality rates for laparotomy were 3.92% and for cesarean delivery was 0.24%. Logistic regression demonstrated no difference in the postoperative mortality rate after the Safe Surgery 2020 intervention.

Conclusions

Our results inform national surgical planning in Tanzania by providing a sub-national baseline estimate of postoperative mortality rates for multiple surgical procedures and serve as a basis from which to measure the impact of future surgical quality interventions. Our study showed no improvement in postoperative mortality after implementation of Safe Surgery 2020, possibly due to low power to detect change.
Appendix
Available only for authorised users
Literature
1.
Shrime MG, Bickler SW, Alkire BC et al (2015) Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 3:S8–S9CrossRef
2.
Meara JG, Leather AJM, Hagander L et al (2015) Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386(9993):569–624CrossRef
3.
Bickler SN, Weiser TG, Kassebaum N et al (2015) Global burden of surgical conditions. In: Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN (eds) Essential surgery: disease control priorities, 3 Ed (vol 1). The World Bank, Washington (DC), p 25
4.
Jauniaux E, Grobman WA (2016) Caesarean section: Introduction to the ‘World’s No. 1’ surgical procedure. In: Sathya D (ed) Textbook of caesarean section. Oxford University Press, OxfordCrossRef
5.
Molina G, Weiser TG, Lipsitz SR et al (2015) Relationship between cesarean delivery rate and maternal and neonatal mortality. JAMA 314(21):2263–2270CrossRef
6.
Biccard BM, Madiba TE, Kluyts H-L et al (2018) Perioperative patient outcomes in the African surgical outcomes study: a 7-day prospective observational cohort study. Lancet LondEngl 391(10130):1589–1598CrossRef
7.
Bishop D, Dyer RA, Maswime S et al (2019) Maternal and neonatal outcomes after caesarean delivery in the African surgical outcomes study: a 7-day prospective observational cohort study. Lancet Glob 7(4):e513–e522CrossRef
8.
Sobhy S, Zamora J, Dharmarajah K et al (2016) Anaesthesia-related maternal mortality in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health 4(5):e320–327CrossRef
9.
Humphreys H (2009) Preventing surgical site infection. Where now? J Hosp Infect 73(4):316–22CrossRef
10.
Shrime MG, Bickler SW, Alkire BC et al (2015) Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 3(Suppl 2):S8–9CrossRef
11.
Marks I, Kamali P, Khan M (2016) Data for the sustainable development of surgical systems: a global collaboration. WDI surgical indicators data collection.
12.
Bosse G, Abels W, Mtatifikolo F et al (2015) Perioperative care and the importance of continuous quality improvement—a controlled intervention study in three tanzanian hospitals. PLoS ONE 10(9):e0136156CrossRef
13.
14.
Alidina S, Kuchukhidze S, Menon G et al (2019) Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania’s Lake Zone: protocol for a quasi-experimental study. BMJ Open 9(10):e031800CrossRef
15.
Ng-Kamstra JS, Arya S, Greenberg SLM et al (2018) Perioperative mortality rates in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Glob Health 3(3):e000810CrossRef
16.
Jaka H, Mchembe MD, Rambau PF et al (2013) Gastric outlet obstruction at Bugando Medical Centre in Northwestern Tanzania: a prospective review of 184 cases. BMC Surg 13:41CrossRef
17.
Dare AJ, Ng-Kamstra JS, Patra J et al (2015) Deaths from acute abdominal conditions and geographical access to surgical care in India: a nationally representative spatial analysis. Lancet Glob Health 3(10):e646–653CrossRef
18.
Gebhardt GS, Fawcus S, Moodley J et al (2015) Maternal death and caesarean section in South Africa: results from the 2011–2013 saving mothers report of the national committee for confidential enquiries into maternal deaths. South Afr Med J 105(4):287–291CrossRef
19.
Sobhy S, Arroyo-Manzano D, Murugesu N et al (2019) Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysis. Lancet 393(10184):1973–1982CrossRef
20.
Ariyaratnam R, Palmqvist CL, Hider P et al (2015) Toward a standard approach to measurement and reporting of perioperative mortality rate as a global indicator for surgery. Surgery 158(1):17–26CrossRef
21.
Guest GD, McLeod E, Perry WRG et al (2017) Collecting data for global surgical indicators: a collaborative approach in the Pacific region. BMJ Glob Health 2(4):e000376CrossRef
22.
Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360(5):491–499CrossRef
23.
Collaborative GlobalSurg (2019) Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy. Br J Surg 106(2):e103–e112CrossRef
24.
25.
26.
Nepogodiev D, Martin J, Biccard B et al (2019) Global burden of postoperative death. Lancet LondEngl 393(10170):401CrossRef
27.
Kruk ME, Gage AD, Arsenault C et al (2018) High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health 6(11):e1196–e1252CrossRef
Metadata
Title
In-Hospital Postoperative Mortality Rates for Selected Procedures in Tanzania’s Lake Zone
Authors
Taylor Wurdeman
Christopher Strader
Shehnaz Alidina
David Barash
Isabelle Citron
Ntuli Kapologwe
Erastus Maina
Fabian Massaga
Adelina Mazhiqi
John G. Meara
Gopal Menon
Cheri Reynolds
Meaghan Sydlowski
John Varallo
Sarah Maongezi
Mpoki Ulisubisya
Publication date
01-01-2021
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 1/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-020-05802-w

Other articles of this Issue 1/2021

World Journal of Surgery 1/2021 Go to the issue

Original Scientific Report

Donor Site Morbidity of Patients Receiving Vertical Rectus Abdominis Myocutaneous Flap for Perineal, Vaginal or Inguinal Reconstruction

Original Scientific Report

Impact of Multidisciplinary Audit of Enhanced Recovery After Surgery (ERAS)® Programs at a Single Institution

Invited Commentary

Patient-Centered Surgical Care Meets the Social Determinants of Health

Original Scientific Report

Prognostic Utility of the Glasgow Prognostic Score for the Long-Term Outcomes After Liver Resection for Intrahepatic Cholangiocarcinoma: A Multi-institutional Study

Original Scientific Report

The Application of Uniportal Video-Assisted Thoracoscopic Anatomical Segmentectomy for Lung Resection: A Retrospective Clinical Study

Original Scientific Report

Early Enteral Nutrition Could Reduce Risk of Recurrent Leakage After Definitive Resection of Anastomotic Leakage After Colorectal Cancer Surgery