Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.
Identifieur interne : 000428 ( Main/Exploration ); précédent : 000427; suivant : 000429Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.
Auteurs : Bruce M. Biccard [Afrique du Sud] ; Thandinkosi E. Madiba [Afrique du Sud] ; Hyla-Louise Kluyts [Afrique du Sud] ; Dolly M. Munlemvo ; Farai D. Madzimbamuto [Zimbabwe] ; Apollo Basenero [Namibie] ; Christina S. Gordon [Namibie] ; Coulibaly Youssouf [Mali] ; Sylvia R. Rakotoarison [Madagascar] ; Veekash Gobin ; Ahmadou L. Samateh [Gambie] ; Chaibou M. Sani ; Akinyinka O. Omigbodun [Nigeria] ; Simbo D. Amanor-Boadu [Nigeria] ; Janat T. Tumukunde [Ouganda] ; Tonya M. Esterhuizen [Afrique du Sud] ; Yannick Le Manach [Canada] ; Patrice Forget [Belgique] ; Abdulaziz M. Elkhogia [Libye] ; Ryad M. Mehyaoui [Algérie] ; Eugene Zoumeno [Bénin] ; Gabriel Ndayisaba [Burundi] ; Henry Ndasi [Cameroun] ; Andrew K N. Ndonga [Kenya] ; Zipporah W W. Ngumi [Kenya] ; Ushmah P. Patel [Zambie] ; Daniel Zemenfes Ashebir [Éthiopie] ; Akwasi A K. Antwi-Kusi [Ghana] ; Bernard Mbwele [Tanzanie] ; Hamza Doles Sama [Togo] ; Mahmoud Elfiky [Égypte] ; Maher A. Fawzy [Égypte] ; Rupert M. Pearse [Royaume-Uni]Source :
- Lancet (London, England) [ 1474-547X ] ; 2018.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Afrique (épidémiologie), Complications postopératoires (mortalité), Complications postopératoires (épidémiologie), Césarienne (MeSH), Femelle (MeSH), Grossesse (MeSH), Humains (MeSH), Hôpitaux (MeSH), Indice de gravité de la maladie (MeSH), Infection de plaie opératoire (mortalité), Infection de plaie opératoire (épidémiologie), Jeune adulte (MeSH), Modèles logistiques (MeSH), Mortalité (MeSH), Mâle (MeSH), Procédures de chirurgie cardiaque (MeSH), Procédures de chirurgie digestive (MeSH), Procédures de chirurgie gynécologique (MeSH), Procédures de chirurgie opératoire (MeSH), Procédures de chirurgie thoracique (MeSH), Procédures de chirurgie urologique (MeSH), Procédures de chirurgie vasculaire (MeSH), Procédures de neurochirurgie (MeSH), Procédures orthopédiques (MeSH), Période postopératoire (MeSH), Santé mondiale (MeSH), Études de cohortes (MeSH), Études prospectives (MeSH).
- MESH :
- mortalité : Complications postopératoires, Infection de plaie opératoire.
- épidémiologie : Afrique, Complications postopératoires, Infection de plaie opératoire.
- Adulte, Adulte d'âge moyen, Césarienne, Femelle, Grossesse, Humains, Hôpitaux, Indice de gravité de la maladie, Jeune adulte, Modèles logistiques, Mortalité, Mâle, Procédures de chirurgie cardiaque, Procédures de chirurgie digestive, Procédures de chirurgie gynécologique, Procédures de chirurgie opératoire, Procédures de chirurgie thoracique, Procédures de chirurgie urologique, Procédures de chirurgie vasculaire, Procédures de neurochirurgie, Procédures orthopédiques, Période postopératoire, Santé mondiale, Études de cohortes, Études prospectives.
English descriptors
- KwdEn :
- Adult (MeSH), Africa (epidemiology), Cardiac Surgical Procedures (MeSH), Cesarean Section (MeSH), Cohort Studies (MeSH), Digestive System Surgical Procedures (MeSH), Female (MeSH), Global Health (MeSH), Gynecologic Surgical Procedures (MeSH), Hospitals (MeSH), Humans (MeSH), Logistic Models (MeSH), Male (MeSH), Middle Aged (MeSH), Mortality (MeSH), Neurosurgical Procedures (MeSH), Orthopedic Procedures (MeSH), Outcome Assessment, Health Care (MeSH), Postoperative Complications (epidemiology), Postoperative Complications (mortality), Postoperative Period (MeSH), Pregnancy (MeSH), Prospective Studies (MeSH), Severity of Illness Index (MeSH), Surgical Procedures, Operative (MeSH), Surgical Wound Infection (epidemiology), Surgical Wound Infection (mortality), Thoracic Surgical Procedures (MeSH), Urologic Surgical Procedures (MeSH), Vascular Surgical Procedures (MeSH), Young Adult (MeSH).
- MESH :
- geographic , epidemiology : Africa.
- epidemiology : Postoperative Complications, Surgical Wound Infection.
- mortality : Postoperative Complications, Surgical Wound Infection.
- Adult, Cardiac Surgical Procedures, Cesarean Section, Cohort Studies, Digestive System Surgical Procedures, Female, Global Health, Gynecologic Surgical Procedures, Hospitals, Humans, Logistic Models, Male, Middle Aged, Mortality, Neurosurgical Procedures, Orthopedic Procedures, Outcome Assessment, Health Care, Postoperative Period, Pregnancy, Prospective Studies, Severity of Illness Index, Surgical Procedures, Operative, Thoracic Surgical Procedures, Urologic Surgical Procedures, Vascular Surgical Procedures, Young Adult.
Abstract
BACKGROUND
There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa.
METHODS
We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899).
FINDINGS
We recruited 11 422 patients (median 29 [IQR 10-70]) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000-2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2-1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65-578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years [SD 16·1]), with a lower risk profile (American Society of Anesthesiologists median score 1 [IQR 1-2]) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18·2%, 95% CI 17·4-18·9]) of 10 885 patients. 239 (2·1%) of 11 193 patients died, 225 (94·1%) after the day of surgery. Infection was the most common complication (1156 [10·2%] of 10 970 patients), of whom 112 (9·7%) died.
INTERPRETATION
Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective.
FUNDING
Medical Research Council of South Africa.
DOI: 10.1016/S0140-6736(18)30001-1
PubMed: 29306587
Affiliations:
- Afrique du Sud, Algérie, Belgique, Burundi, Bénin, Cameroun, Canada, Gambie, Ghana, Kenya, Libye, Madagascar, Mali, Namibie, Nigeria, Ouganda, Royaume-Uni, Tanzanie, Togo, Zambie, Zimbabwe, Égypte, Éthiopie
- Angleterre, Grand Londres, Région de Bruxelles-Capitale, État d'Oyo
- Bruxelles, Ibadan, Londres
- Université d'Ibadan, Université de Londres
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Le document en format XML
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Electronic address: bruce.biccard@uct.ac.za.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town</wicri:regionArea><wicri:noRegion>University of Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Madiba, Thandinkosi E" sort="Madiba, Thandinkosi E" uniqKey="Madiba T" first="Thandinkosi E" last="Madiba">Thandinkosi E. 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Rakotoarison</name><affiliation wicri:level="1"><nlm:affiliation>LOT II M 46 R, Androhibe, Tana, Madagascar.</nlm:affiliation><country xml:lang="fr">Madagascar</country><wicri:regionArea>LOT II M 46 R, Androhibe, Tana</wicri:regionArea><wicri:noRegion>Tana</wicri:noRegion></affiliation></author><author><name sortKey="Gobin, Veekash" sort="Gobin, Veekash" uniqKey="Gobin V" first="Veekash" last="Gobin">Veekash Gobin</name><affiliation><nlm:affiliation>Ministry of Health and Quality of Life, Jawaharlal Nehru Hospital, Rose Belle, Mauritius.</nlm:affiliation><wicri:noCountry code="subField">Mauritius</wicri:noCountry></affiliation></author><author><name sortKey="Samateh, Ahmadou L" sort="Samateh, Ahmadou L" uniqKey="Samateh A" first="Ahmadou L" last="Samateh">Ahmadou L. Samateh</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, The Gambia.</nlm:affiliation><country xml:lang="fr">Gambie</country><wicri:regionArea>Department of Surgery, Edward Francis Small Teaching Hospital, Banjul</wicri:regionArea><wicri:noRegion>Banjul</wicri:noRegion></affiliation></author><author><name sortKey="Sani, Chaibou M" sort="Sani, Chaibou M" uniqKey="Sani C" first="Chaibou M" last="Sani">Chaibou M. Sani</name><affiliation><nlm:affiliation>Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Niamey, Republic of Niger.</nlm:affiliation><wicri:noCountry code="subField">Republic of Niger</wicri:noCountry></affiliation></author><author><name sortKey="Omigbodun, Akinyinka O" sort="Omigbodun, Akinyinka O" uniqKey="Omigbodun A" first="Akinyinka O" last="Omigbodun">Akinyinka O. Omigbodun</name><affiliation wicri:level="4"><nlm:affiliation>Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.</nlm:affiliation><country xml:lang="fr">Nigeria</country><wicri:regionArea>Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan</wicri:regionArea><orgName type="university">Université d'Ibadan</orgName><placeName><settlement type="city">Ibadan</settlement><region type="region">État d'Oyo</region></placeName></affiliation></author><author><name sortKey="Amanor Boadu, Simbo D" sort="Amanor Boadu, Simbo D" uniqKey="Amanor Boadu S" first="Simbo D" last="Amanor-Boadu">Simbo D. Amanor-Boadu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia, University College Hospital, Ibadan, Nigeria.</nlm:affiliation><country xml:lang="fr">Nigeria</country><wicri:regionArea>Department of Anaesthesia, University College Hospital, Ibadan</wicri:regionArea><wicri:noRegion>Ibadan</wicri:noRegion></affiliation></author><author><name sortKey="Tumukunde, Janat T" sort="Tumukunde, Janat T" uniqKey="Tumukunde J" first="Janat T" last="Tumukunde">Janat T. Tumukunde</name><affiliation wicri:level="1"><nlm:affiliation>Anaesthesiology, Makerere University, Kampala, Uganda.</nlm:affiliation><country xml:lang="fr">Ouganda</country><wicri:regionArea>Anaesthesiology, Makerere University, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Esterhuizen, Tonya M" sort="Esterhuizen, Tonya M" uniqKey="Esterhuizen T" first="Tonya M" last="Esterhuizen">Tonya M. Esterhuizen</name><affiliation wicri:level="1"><nlm:affiliation>Centre for Evidence Based Health Care, Stellenbosch University, Stellenbosch, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Evidence Based Health Care, Stellenbosch University, Stellenbosch</wicri:regionArea><wicri:noRegion>Stellenbosch</wicri:noRegion></affiliation></author><author><name sortKey="Manach, Yannick Le" sort="Manach, Yannick Le" uniqKey="Manach Y" first="Yannick Le" last="Manach">Yannick Le Manach</name><affiliation wicri:level="1"><nlm:affiliation>Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, ON, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Forget, Patrice" sort="Forget, Patrice" uniqKey="Forget P" first="Patrice" last="Forget">Patrice Forget</name><affiliation wicri:level="3"><nlm:affiliation>Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Anesthesiology and Perioperative Medicine, Brussels, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Anesthesiology and Perioperative Medicine, Brussels</wicri:regionArea><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName></affiliation></author><author><name sortKey="Elkhogia, Abdulaziz M" sort="Elkhogia, Abdulaziz M" uniqKey="Elkhogia A" first="Abdulaziz M" last="Elkhogia">Abdulaziz M. Elkhogia</name><affiliation wicri:level="1"><nlm:affiliation>Anaesthesia Department, Tripoli Medical Centre, Tripoli, Libya.</nlm:affiliation><country xml:lang="fr">Libye</country><wicri:regionArea>Anaesthesia Department, Tripoli Medical Centre, Tripoli</wicri:regionArea><wicri:noRegion>Tripoli</wicri:noRegion></affiliation></author><author><name sortKey="Mehyaoui, Ryad M" sort="Mehyaoui, Ryad M" uniqKey="Mehyaoui R" first="Ryad M" last="Mehyaoui">Ryad M. Mehyaoui</name><affiliation wicri:level="1"><nlm:affiliation>Hospital of Cardiovasculaire Pathology, Universitar Hospital, Algeria.</nlm:affiliation><country xml:lang="fr">Algérie</country><wicri:regionArea>Hospital of Cardiovasculaire Pathology, Universitar Hospital</wicri:regionArea><wicri:noRegion>Universitar Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Zoumeno, Eugene" sort="Zoumeno, Eugene" uniqKey="Zoumeno E" first="Eugene" last="Zoumeno">Eugene Zoumeno</name><affiliation wicri:level="1"><nlm:affiliation>Faculté des Sciences de la Santé de Cotonou, Hôpital de la mère et de l'enfant, Lagune de Cotonou, Benin.</nlm:affiliation><country xml:lang="fr">Bénin</country><wicri:regionArea>Faculté des Sciences de la Santé de Cotonou, Hôpital de la mère et de l'enfant, Lagune de Cotonou</wicri:regionArea><wicri:noRegion>Lagune de Cotonou</wicri:noRegion></affiliation></author><author><name sortKey="Ndayisaba, Gabriel" sort="Ndayisaba, Gabriel" uniqKey="Ndayisaba G" first="Gabriel" last="Ndayisaba">Gabriel Ndayisaba</name><affiliation wicri:level="1"><nlm:affiliation>Kamenge Teaching Hospital, Department of Surgery, Bujumbura, Burundi.</nlm:affiliation><country xml:lang="fr">Burundi</country><wicri:regionArea>Kamenge Teaching Hospital, Department of Surgery, Bujumbura</wicri:regionArea><wicri:noRegion>Bujumbura</wicri:noRegion></affiliation></author><author><name sortKey="Ndasi, Henry" sort="Ndasi, Henry" uniqKey="Ndasi H" first="Henry" last="Ndasi">Henry Ndasi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Orthopaedics and General Surgery, Baptist Hospital, Mutengene, Cameroon.</nlm:affiliation><country xml:lang="fr">Cameroun</country><wicri:regionArea>Department of Orthopaedics and General Surgery, Baptist Hospital, Mutengene</wicri:regionArea><wicri:noRegion>Mutengene</wicri:noRegion></affiliation></author><author><name sortKey="Ndonga, Andrew K N" sort="Ndonga, Andrew K N" uniqKey="Ndonga A" first="Andrew K N" last="Ndonga">Andrew K N. Ndonga</name><affiliation wicri:level="1"><nlm:affiliation>General and Gastrosurgery, Mater Hospital, Kenya.</nlm:affiliation><country xml:lang="fr">Kenya</country><wicri:regionArea>General and Gastrosurgery, Mater Hospital</wicri:regionArea><wicri:noRegion>Mater Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Ngumi, Zipporah W W" sort="Ngumi, Zipporah W W" uniqKey="Ngumi Z" first="Zipporah W W" last="Ngumi">Zipporah W W. Ngumi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia, University of Nairobi School of Medicine, Nairobi, Kenya.</nlm:affiliation><country xml:lang="fr">Kenya</country><wicri:regionArea>Department of Anaesthesia, University of Nairobi School of Medicine, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Patel, Ushmah P" sort="Patel, Ushmah P" uniqKey="Patel U" first="Ushmah P" last="Patel">Ushmah P. Patel</name><affiliation wicri:level="1"><nlm:affiliation>Anaesthesiology, University Teaching Hospital, Lusaka, Zambia.</nlm:affiliation><country xml:lang="fr">Zambie</country><wicri:regionArea>Anaesthesiology, University Teaching Hospital, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Ashebir, Daniel Zemenfes" sort="Ashebir, Daniel Zemenfes" uniqKey="Ashebir D" first="Daniel Zemenfes" last="Ashebir">Daniel Zemenfes Ashebir</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.</nlm:affiliation><country xml:lang="fr">Éthiopie</country><wicri:regionArea>Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa</wicri:regionArea><wicri:noRegion>Addis Ababa</wicri:noRegion></affiliation></author><author><name sortKey="Antwi Kusi, Akwasi A K" sort="Antwi Kusi, Akwasi A K" uniqKey="Antwi Kusi A" first="Akwasi A K" last="Antwi-Kusi">Akwasi A K. Antwi-Kusi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.</nlm:affiliation><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Mbwele, Bernard" sort="Mbwele, Bernard" uniqKey="Mbwele B" first="Bernard" last="Mbwele">Bernard Mbwele</name><affiliation wicri:level="1"><nlm:affiliation>HIV/AIDS Care and Treatment & PMTCT, Christian Social Service Commission, Mwanza, Tanzania.</nlm:affiliation><country xml:lang="fr">Tanzanie</country><wicri:regionArea>HIV/AIDS Care and Treatment & PMTCT, Christian Social Service Commission, Mwanza</wicri:regionArea><wicri:noRegion>Mwanza</wicri:noRegion></affiliation></author><author><name sortKey="Sama, Hamza Doles" sort="Sama, Hamza Doles" uniqKey="Sama H" first="Hamza Doles" last="Sama">Hamza Doles Sama</name><affiliation wicri:level="1"><nlm:affiliation>Anaesthesia Intensive Care Medicine Pain Management, Sylvanus Olympio University Teaching Hospital, Lomé TOGO, Togo.</nlm:affiliation><country xml:lang="fr">Togo</country><wicri:regionArea>Anaesthesia Intensive Care Medicine Pain Management, Sylvanus Olympio University Teaching Hospital, Lomé TOGO</wicri:regionArea><wicri:noRegion>Lomé TOGO</wicri:noRegion></affiliation></author><author><name sortKey="Elfiky, Mahmoud" sort="Elfiky, Mahmoud" uniqKey="Elfiky M" first="Mahmoud" last="Elfiky">Mahmoud Elfiky</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, Cairo University, Cairo, Egypt.</nlm:affiliation><country xml:lang="fr">Égypte</country><wicri:regionArea>Department of Surgery, Cairo University, Cairo</wicri:regionArea><wicri:noRegion>Cairo</wicri:noRegion></affiliation></author><author><name sortKey="Fawzy, Maher A" sort="Fawzy, Maher A" uniqKey="Fawzy M" first="Maher A" last="Fawzy">Maher A. Fawzy</name><affiliation wicri:level="1"><nlm:affiliation>Anesthesia, ICU & Pain Management Departments, Faculty of Medicine, Cairo University, Cairo, Egypt.</nlm:affiliation><country xml:lang="fr">Égypte</country><wicri:regionArea>Anesthesia, ICU & Pain Management Departments, Faculty of Medicine, Cairo University, Cairo</wicri:regionArea><wicri:noRegion>Cairo</wicri:noRegion></affiliation></author><author><name sortKey="Pearse, Rupert M" sort="Pearse, Rupert M" uniqKey="Pearse R" first="Rupert M" last="Pearse">Rupert M. Pearse</name><affiliation wicri:level="4"><nlm:affiliation>Intensive Care Medicine, Queen Mary University of London, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Intensive Care Medicine, Queen Mary University of London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">Université de Londres</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2018">2018</date><idno type="RBID">pubmed:29306587</idno><idno type="pmid">29306587</idno><idno type="doi">10.1016/S0140-6736(18)30001-1</idno><idno type="wicri:Area/PubMed/Corpus">000383</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000383</idno><idno type="wicri:Area/PubMed/Curation">000382</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">000382</idno><idno type="wicri:Area/PubMed/Checkpoint">000327</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">000327</idno><idno type="wicri:Area/Main/Merge">000428</idno><idno type="wicri:Area/Main/Curation">000428</idno><idno type="wicri:Area/Main/Exploration">000428</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.</title><author><name sortKey="Biccard, Bruce M" sort="Biccard, Bruce M" uniqKey="Biccard B" first="Bruce M" last="Biccard">Bruce M. Biccard</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa. Electronic address: bruce.biccard@uct.ac.za.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town</wicri:regionArea><wicri:noRegion>University of Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Madiba, Thandinkosi E" sort="Madiba, Thandinkosi E" uniqKey="Madiba T" first="Thandinkosi E" last="Madiba">Thandinkosi E. Madiba</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, University of KwaZulu-Natal, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Surgery, University of KwaZulu-Natal</wicri:regionArea><wicri:noRegion>University of KwaZulu-Natal</wicri:noRegion></affiliation></author><author><name sortKey="Kluyts, Hyla Louise" sort="Kluyts, Hyla Louise" uniqKey="Kluyts H" first="Hyla-Louise" last="Kluyts">Hyla-Louise Kluyts</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria</wicri:regionArea><wicri:noRegion>Pretoria</wicri:noRegion></affiliation></author><author><name sortKey="Munlemvo, Dolly M" sort="Munlemvo, Dolly M" uniqKey="Munlemvo D" first="Dolly M" last="Munlemvo">Dolly M. Munlemvo</name><affiliation><nlm:affiliation>Anaesthesiology, University Hospital of Kinshasha, Democratic Republic of the Congo.</nlm:affiliation><wicri:noCountry code="subField">Democratic Republic of the Congo</wicri:noCountry></affiliation></author><author><name sortKey="Madzimbamuto, Farai D" sort="Madzimbamuto, Farai D" uniqKey="Madzimbamuto F" first="Farai D" last="Madzimbamuto">Farai D. Madzimbamuto</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Avondale, Harare, Zimbabwe.</nlm:affiliation><country xml:lang="fr">Zimbabwe</country><wicri:regionArea>Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Avondale, Harare</wicri:regionArea><wicri:noRegion>Harare</wicri:noRegion></affiliation></author><author><name sortKey="Basenero, Apollo" sort="Basenero, Apollo" uniqKey="Basenero A" first="Apollo" last="Basenero">Apollo Basenero</name><affiliation wicri:level="1"><nlm:affiliation>Ministry of Health and Social Services Namibia, Windhoek, Namibia.</nlm:affiliation><country xml:lang="fr">Namibie</country><wicri:regionArea>Ministry of Health and Social Services Namibia, Windhoek</wicri:regionArea><wicri:noRegion>Windhoek</wicri:noRegion></affiliation></author><author><name sortKey="Gordon, Christina S" sort="Gordon, Christina S" uniqKey="Gordon C" first="Christina S" last="Gordon">Christina S. Gordon</name><affiliation wicri:level="1"><nlm:affiliation>Ministry of Health and Social Services Namibia, Windhoek, Namibia.</nlm:affiliation><country xml:lang="fr">Namibie</country><wicri:regionArea>Ministry of Health and Social Services Namibia, Windhoek</wicri:regionArea><wicri:noRegion>Windhoek</wicri:noRegion></affiliation></author><author><name sortKey="Youssouf, Coulibaly" sort="Youssouf, Coulibaly" uniqKey="Youssouf C" first="Coulibaly" last="Youssouf">Coulibaly Youssouf</name><affiliation wicri:level="1"><nlm:affiliation>Faculté de Médicine de Bamako, Bamako, Mali.</nlm:affiliation><country xml:lang="fr">Mali</country><wicri:regionArea>Faculté de Médicine de Bamako, Bamako</wicri:regionArea><wicri:noRegion>Bamako</wicri:noRegion></affiliation></author><author><name sortKey="Rakotoarison, Sylvia R" sort="Rakotoarison, Sylvia R" uniqKey="Rakotoarison S" first="Sylvia R" last="Rakotoarison">Sylvia R. Rakotoarison</name><affiliation wicri:level="1"><nlm:affiliation>LOT II M 46 R, Androhibe, Tana, Madagascar.</nlm:affiliation><country xml:lang="fr">Madagascar</country><wicri:regionArea>LOT II M 46 R, Androhibe, Tana</wicri:regionArea><wicri:noRegion>Tana</wicri:noRegion></affiliation></author><author><name sortKey="Gobin, Veekash" sort="Gobin, Veekash" uniqKey="Gobin V" first="Veekash" last="Gobin">Veekash Gobin</name><affiliation><nlm:affiliation>Ministry of Health and Quality of Life, Jawaharlal Nehru Hospital, Rose Belle, Mauritius.</nlm:affiliation><wicri:noCountry code="subField">Mauritius</wicri:noCountry></affiliation></author><author><name sortKey="Samateh, Ahmadou L" sort="Samateh, Ahmadou L" uniqKey="Samateh A" first="Ahmadou L" last="Samateh">Ahmadou L. Samateh</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, The Gambia.</nlm:affiliation><country xml:lang="fr">Gambie</country><wicri:regionArea>Department of Surgery, Edward Francis Small Teaching Hospital, Banjul</wicri:regionArea><wicri:noRegion>Banjul</wicri:noRegion></affiliation></author><author><name sortKey="Sani, Chaibou M" sort="Sani, Chaibou M" uniqKey="Sani C" first="Chaibou M" last="Sani">Chaibou M. Sani</name><affiliation><nlm:affiliation>Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Niamey, Republic of Niger.</nlm:affiliation><wicri:noCountry code="subField">Republic of Niger</wicri:noCountry></affiliation></author><author><name sortKey="Omigbodun, Akinyinka O" sort="Omigbodun, Akinyinka O" uniqKey="Omigbodun A" first="Akinyinka O" last="Omigbodun">Akinyinka O. Omigbodun</name><affiliation wicri:level="4"><nlm:affiliation>Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.</nlm:affiliation><country xml:lang="fr">Nigeria</country><wicri:regionArea>Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan</wicri:regionArea><orgName type="university">Université d'Ibadan</orgName><placeName><settlement type="city">Ibadan</settlement><region type="region">État d'Oyo</region></placeName></affiliation></author><author><name sortKey="Amanor Boadu, Simbo D" sort="Amanor Boadu, Simbo D" uniqKey="Amanor Boadu S" first="Simbo D" last="Amanor-Boadu">Simbo D. Amanor-Boadu</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia, University College Hospital, Ibadan, Nigeria.</nlm:affiliation><country xml:lang="fr">Nigeria</country><wicri:regionArea>Department of Anaesthesia, University College Hospital, Ibadan</wicri:regionArea><wicri:noRegion>Ibadan</wicri:noRegion></affiliation></author><author><name sortKey="Tumukunde, Janat T" sort="Tumukunde, Janat T" uniqKey="Tumukunde J" first="Janat T" last="Tumukunde">Janat T. Tumukunde</name><affiliation wicri:level="1"><nlm:affiliation>Anaesthesiology, Makerere University, Kampala, Uganda.</nlm:affiliation><country xml:lang="fr">Ouganda</country><wicri:regionArea>Anaesthesiology, Makerere University, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Esterhuizen, Tonya M" sort="Esterhuizen, Tonya M" uniqKey="Esterhuizen T" first="Tonya M" last="Esterhuizen">Tonya M. Esterhuizen</name><affiliation wicri:level="1"><nlm:affiliation>Centre for Evidence Based Health Care, Stellenbosch University, Stellenbosch, South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Centre for Evidence Based Health Care, Stellenbosch University, Stellenbosch</wicri:regionArea><wicri:noRegion>Stellenbosch</wicri:noRegion></affiliation></author><author><name sortKey="Manach, Yannick Le" sort="Manach, Yannick Le" uniqKey="Manach Y" first="Yannick Le" last="Manach">Yannick Le Manach</name><affiliation wicri:level="1"><nlm:affiliation>Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, ON, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, ON</wicri:regionArea><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Forget, Patrice" sort="Forget, Patrice" uniqKey="Forget P" first="Patrice" last="Forget">Patrice Forget</name><affiliation wicri:level="3"><nlm:affiliation>Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Anesthesiology and Perioperative Medicine, Brussels, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Anesthesiology and Perioperative Medicine, Brussels</wicri:regionArea><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName></affiliation></author><author><name sortKey="Elkhogia, Abdulaziz M" sort="Elkhogia, Abdulaziz M" uniqKey="Elkhogia A" first="Abdulaziz M" last="Elkhogia">Abdulaziz M. Elkhogia</name><affiliation wicri:level="1"><nlm:affiliation>Anaesthesia Department, Tripoli Medical Centre, Tripoli, Libya.</nlm:affiliation><country xml:lang="fr">Libye</country><wicri:regionArea>Anaesthesia Department, Tripoli Medical Centre, Tripoli</wicri:regionArea><wicri:noRegion>Tripoli</wicri:noRegion></affiliation></author><author><name sortKey="Mehyaoui, Ryad M" sort="Mehyaoui, Ryad M" uniqKey="Mehyaoui R" first="Ryad M" last="Mehyaoui">Ryad M. Mehyaoui</name><affiliation wicri:level="1"><nlm:affiliation>Hospital of Cardiovasculaire Pathology, Universitar Hospital, Algeria.</nlm:affiliation><country xml:lang="fr">Algérie</country><wicri:regionArea>Hospital of Cardiovasculaire Pathology, Universitar Hospital</wicri:regionArea><wicri:noRegion>Universitar Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Zoumeno, Eugene" sort="Zoumeno, Eugene" uniqKey="Zoumeno E" first="Eugene" last="Zoumeno">Eugene Zoumeno</name><affiliation wicri:level="1"><nlm:affiliation>Faculté des Sciences de la Santé de Cotonou, Hôpital de la mère et de l'enfant, Lagune de Cotonou, Benin.</nlm:affiliation><country xml:lang="fr">Bénin</country><wicri:regionArea>Faculté des Sciences de la Santé de Cotonou, Hôpital de la mère et de l'enfant, Lagune de Cotonou</wicri:regionArea><wicri:noRegion>Lagune de Cotonou</wicri:noRegion></affiliation></author><author><name sortKey="Ndayisaba, Gabriel" sort="Ndayisaba, Gabriel" uniqKey="Ndayisaba G" first="Gabriel" last="Ndayisaba">Gabriel Ndayisaba</name><affiliation wicri:level="1"><nlm:affiliation>Kamenge Teaching Hospital, Department of Surgery, Bujumbura, Burundi.</nlm:affiliation><country xml:lang="fr">Burundi</country><wicri:regionArea>Kamenge Teaching Hospital, Department of Surgery, Bujumbura</wicri:regionArea><wicri:noRegion>Bujumbura</wicri:noRegion></affiliation></author><author><name sortKey="Ndasi, Henry" sort="Ndasi, Henry" uniqKey="Ndasi H" first="Henry" last="Ndasi">Henry Ndasi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Orthopaedics and General Surgery, Baptist Hospital, Mutengene, Cameroon.</nlm:affiliation><country xml:lang="fr">Cameroun</country><wicri:regionArea>Department of Orthopaedics and General Surgery, Baptist Hospital, Mutengene</wicri:regionArea><wicri:noRegion>Mutengene</wicri:noRegion></affiliation></author><author><name sortKey="Ndonga, Andrew K N" sort="Ndonga, Andrew K N" uniqKey="Ndonga A" first="Andrew K N" last="Ndonga">Andrew K N. Ndonga</name><affiliation wicri:level="1"><nlm:affiliation>General and Gastrosurgery, Mater Hospital, Kenya.</nlm:affiliation><country xml:lang="fr">Kenya</country><wicri:regionArea>General and Gastrosurgery, Mater Hospital</wicri:regionArea><wicri:noRegion>Mater Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Ngumi, Zipporah W W" sort="Ngumi, Zipporah W W" uniqKey="Ngumi Z" first="Zipporah W W" last="Ngumi">Zipporah W W. Ngumi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia, University of Nairobi School of Medicine, Nairobi, Kenya.</nlm:affiliation><country xml:lang="fr">Kenya</country><wicri:regionArea>Department of Anaesthesia, University of Nairobi School of Medicine, Nairobi</wicri:regionArea><wicri:noRegion>Nairobi</wicri:noRegion></affiliation></author><author><name sortKey="Patel, Ushmah P" sort="Patel, Ushmah P" uniqKey="Patel U" first="Ushmah P" last="Patel">Ushmah P. Patel</name><affiliation wicri:level="1"><nlm:affiliation>Anaesthesiology, University Teaching Hospital, Lusaka, Zambia.</nlm:affiliation><country xml:lang="fr">Zambie</country><wicri:regionArea>Anaesthesiology, University Teaching Hospital, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Ashebir, Daniel Zemenfes" sort="Ashebir, Daniel Zemenfes" uniqKey="Ashebir D" first="Daniel Zemenfes" last="Ashebir">Daniel Zemenfes Ashebir</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.</nlm:affiliation><country xml:lang="fr">Éthiopie</country><wicri:regionArea>Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa</wicri:regionArea><wicri:noRegion>Addis Ababa</wicri:noRegion></affiliation></author><author><name sortKey="Antwi Kusi, Akwasi A K" sort="Antwi Kusi, Akwasi A K" uniqKey="Antwi Kusi A" first="Akwasi A K" last="Antwi-Kusi">Akwasi A K. Antwi-Kusi</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.</nlm:affiliation><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Mbwele, Bernard" sort="Mbwele, Bernard" uniqKey="Mbwele B" first="Bernard" last="Mbwele">Bernard Mbwele</name><affiliation wicri:level="1"><nlm:affiliation>HIV/AIDS Care and Treatment & PMTCT, Christian Social Service Commission, Mwanza, Tanzania.</nlm:affiliation><country xml:lang="fr">Tanzanie</country><wicri:regionArea>HIV/AIDS Care and Treatment & PMTCT, Christian Social Service Commission, Mwanza</wicri:regionArea><wicri:noRegion>Mwanza</wicri:noRegion></affiliation></author><author><name sortKey="Sama, Hamza Doles" sort="Sama, Hamza Doles" uniqKey="Sama H" first="Hamza Doles" last="Sama">Hamza Doles Sama</name><affiliation wicri:level="1"><nlm:affiliation>Anaesthesia Intensive Care Medicine Pain Management, Sylvanus Olympio University Teaching Hospital, Lomé TOGO, Togo.</nlm:affiliation><country xml:lang="fr">Togo</country><wicri:regionArea>Anaesthesia Intensive Care Medicine Pain Management, Sylvanus Olympio University Teaching Hospital, Lomé TOGO</wicri:regionArea><wicri:noRegion>Lomé TOGO</wicri:noRegion></affiliation></author><author><name sortKey="Elfiky, Mahmoud" sort="Elfiky, Mahmoud" uniqKey="Elfiky M" first="Mahmoud" last="Elfiky">Mahmoud Elfiky</name><affiliation wicri:level="1"><nlm:affiliation>Department of Surgery, Cairo University, Cairo, Egypt.</nlm:affiliation><country xml:lang="fr">Égypte</country><wicri:regionArea>Department of Surgery, Cairo University, Cairo</wicri:regionArea><wicri:noRegion>Cairo</wicri:noRegion></affiliation></author><author><name sortKey="Fawzy, Maher A" sort="Fawzy, Maher A" uniqKey="Fawzy M" first="Maher A" last="Fawzy">Maher A. Fawzy</name><affiliation wicri:level="1"><nlm:affiliation>Anesthesia, ICU & Pain Management Departments, Faculty of Medicine, Cairo University, Cairo, Egypt.</nlm:affiliation><country xml:lang="fr">Égypte</country><wicri:regionArea>Anesthesia, ICU & Pain Management Departments, Faculty of Medicine, Cairo University, Cairo</wicri:regionArea><wicri:noRegion>Cairo</wicri:noRegion></affiliation></author><author><name sortKey="Pearse, Rupert M" sort="Pearse, Rupert M" uniqKey="Pearse R" first="Rupert M" last="Pearse">Rupert M. Pearse</name><affiliation wicri:level="4"><nlm:affiliation>Intensive Care Medicine, Queen Mary University of London, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Intensive Care Medicine, Queen Mary University of London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">Université de Londres</orgName></affiliation></author></analytic><series><title level="j">Lancet (London, England)</title><idno type="eISSN">1474-547X</idno><imprint><date when="2018" type="published">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Africa (epidemiology)</term><term>Cardiac Surgical Procedures (MeSH)</term><term>Cesarean Section (MeSH)</term><term>Cohort Studies (MeSH)</term><term>Digestive System Surgical Procedures (MeSH)</term><term>Female (MeSH)</term><term>Global Health (MeSH)</term><term>Gynecologic Surgical Procedures (MeSH)</term><term>Hospitals (MeSH)</term><term>Humans (MeSH)</term><term>Logistic Models (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Mortality (MeSH)</term><term>Neurosurgical Procedures (MeSH)</term><term>Orthopedic Procedures (MeSH)</term><term>Outcome Assessment, Health Care (MeSH)</term><term>Postoperative Complications (epidemiology)</term><term>Postoperative Complications (mortality)</term><term>Postoperative Period (MeSH)</term><term>Pregnancy (MeSH)</term><term>Prospective Studies (MeSH)</term><term>Severity of Illness Index (MeSH)</term><term>Surgical Procedures, Operative (MeSH)</term><term>Surgical Wound Infection (epidemiology)</term><term>Surgical Wound Infection (mortality)</term><term>Thoracic Surgical Procedures (MeSH)</term><term>Urologic Surgical Procedures (MeSH)</term><term>Vascular Surgical Procedures (MeSH)</term><term>Young Adult (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Afrique (épidémiologie)</term><term>Complications postopératoires (mortalité)</term><term>Complications postopératoires (épidémiologie)</term><term>Césarienne (MeSH)</term><term>Femelle (MeSH)</term><term>Grossesse (MeSH)</term><term>Humains (MeSH)</term><term>Hôpitaux (MeSH)</term><term>Indice de gravité de la maladie (MeSH)</term><term>Infection de plaie opératoire (mortalité)</term><term>Infection de plaie opératoire (épidémiologie)</term><term>Jeune adulte (MeSH)</term><term>Modèles logistiques (MeSH)</term><term>Mortalité (MeSH)</term><term>Mâle (MeSH)</term><term>Procédures de chirurgie cardiaque (MeSH)</term><term>Procédures de chirurgie digestive (MeSH)</term><term>Procédures de chirurgie gynécologique (MeSH)</term><term>Procédures de chirurgie opératoire (MeSH)</term><term>Procédures de chirurgie thoracique (MeSH)</term><term>Procédures de chirurgie urologique (MeSH)</term><term>Procédures de chirurgie vasculaire (MeSH)</term><term>Procédures de neurochirurgie (MeSH)</term><term>Procédures orthopédiques (MeSH)</term><term>Période postopératoire (MeSH)</term><term>Santé mondiale (MeSH)</term><term>Études de cohortes (MeSH)</term><term>Études prospectives (MeSH)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Africa</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Postoperative Complications</term><term>Surgical Wound Infection</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Postoperative Complications</term><term>Surgical Wound Infection</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Complications postopératoires</term><term>Infection de plaie opératoire</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Afrique</term><term>Complications postopératoires</term><term>Infection de plaie opératoire</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Cardiac Surgical Procedures</term><term>Cesarean Section</term><term>Cohort Studies</term><term>Digestive System Surgical Procedures</term><term>Female</term><term>Global Health</term><term>Gynecologic Surgical Procedures</term><term>Hospitals</term><term>Humans</term><term>Logistic Models</term><term>Male</term><term>Middle Aged</term><term>Mortality</term><term>Neurosurgical Procedures</term><term>Orthopedic Procedures</term><term>Outcome Assessment, Health Care</term><term>Postoperative Period</term><term>Pregnancy</term><term>Prospective Studies</term><term>Severity of Illness Index</term><term>Surgical Procedures, Operative</term><term>Thoracic Surgical Procedures</term><term>Urologic Surgical Procedures</term><term>Vascular Surgical Procedures</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Césarienne</term><term>Femelle</term><term>Grossesse</term><term>Humains</term><term>Hôpitaux</term><term>Indice de gravité de la maladie</term><term>Jeune adulte</term><term>Modèles logistiques</term><term>Mortalité</term><term>Mâle</term><term>Procédures de chirurgie cardiaque</term><term>Procédures de chirurgie digestive</term><term>Procédures de chirurgie gynécologique</term><term>Procédures de chirurgie opératoire</term><term>Procédures de chirurgie thoracique</term><term>Procédures de chirurgie urologique</term><term>Procédures de chirurgie vasculaire</term><term>Procédures de neurochirurgie</term><term>Procédures orthopédiques</term><term>Période postopératoire</term><term>Santé mondiale</term><term>Études de cohortes</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>We did a 7-day, international, prospective, observational cohort study of patients aged 18 years and older undergoing any inpatient surgery in 25 countries in Africa (the African Surgical Outcomes Study). We aimed to recruit as many hospitals as possible using a convenience sampling survey, and required data from at least ten hospitals per country (or half the surgical centres if there were fewer than ten hospitals) and data for at least 90% of eligible patients from each site. Each country selected one recruitment week between February and May, 2016. The primary outcome was in-hospital postoperative complications, assessed according to predefined criteria and graded as mild, moderate, or severe. Data were presented as median (IQR), mean (SD), or n (%), and compared using t tests. This study is registered on the South African National Health Research Database (KZ_2015RP7_22) and ClinicalTrials.gov (NCT03044899).</p></div><div type="abstract" xml:lang="en"><p><b>FINDINGS</b></p><p>We recruited 11 422 patients (median 29 [IQR 10-70]) from 247 hospitals during the national cohort weeks. Hospitals served a median population of 810 000 people (IQR 200 000-2 000 000), with a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 (0·2-1·9) per 100 000 population. Hospitals did a median of 212 (IQR 65-578) surgical procedures per 100 000 population each year. Patients were younger (mean age 38·5 years [SD 16·1]), with a lower risk profile (American Society of Anesthesiologists median score 1 [IQR 1-2]) than reported in high-income countries. 1253 (11%) patients were infected with HIV, 6504 procedures (57%) were urgent or emergent, and the most common procedure was caesarean delivery (3792 patients, 33%). Postoperative complications occurred in 1977 (18·2%, 95% CI 17·4-18·9]) of 10 885 patients. 239 (2·1%) of 11 193 patients died, 225 (94·1%) after the day of surgery. Infection was the most common complication (1156 [10·2%] of 10 970 patients), of whom 112 (9·7%) died.</p></div><div type="abstract" xml:lang="en"><p><b>INTERPRETATION</b></p><p>Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective.</p></div><div type="abstract" xml:lang="en"><p><b>FUNDING</b></p><p>Medical Research Council of South Africa.</p></div></front></TEI><affiliations><list><country><li>Afrique du Sud</li><li>Algérie</li><li>Belgique</li><li>Burundi</li><li>Bénin</li><li>Cameroun</li><li>Canada</li><li>Gambie</li><li>Ghana</li><li>Kenya</li><li>Libye</li><li>Madagascar</li><li>Mali</li><li>Namibie</li><li>Nigeria</li><li>Ouganda</li><li>Royaume-Uni</li><li>Tanzanie</li><li>Togo</li><li>Zambie</li><li>Zimbabwe</li><li>Égypte</li><li>Éthiopie</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Région de Bruxelles-Capitale</li><li>État d'Oyo</li></region><settlement><li>Bruxelles</li><li>Ibadan</li><li>Londres</li></settlement><orgName><li>Université d'Ibadan</li><li>Université de Londres</li></orgName></list><tree><noCountry><name sortKey="Gobin, Veekash" sort="Gobin, Veekash" uniqKey="Gobin V" first="Veekash" last="Gobin">Veekash Gobin</name><name sortKey="Munlemvo, Dolly M" sort="Munlemvo, Dolly M" uniqKey="Munlemvo D" first="Dolly M" last="Munlemvo">Dolly M. Munlemvo</name><name sortKey="Sani, Chaibou M" sort="Sani, Chaibou M" uniqKey="Sani C" first="Chaibou M" last="Sani">Chaibou M. Sani</name></noCountry><country name="Afrique du Sud"><noRegion><name sortKey="Biccard, Bruce M" sort="Biccard, Bruce M" uniqKey="Biccard B" first="Bruce M" last="Biccard">Bruce M. Biccard</name></noRegion><name sortKey="Esterhuizen, Tonya M" sort="Esterhuizen, Tonya M" uniqKey="Esterhuizen T" first="Tonya M" last="Esterhuizen">Tonya M. Esterhuizen</name><name sortKey="Kluyts, Hyla Louise" sort="Kluyts, Hyla Louise" uniqKey="Kluyts H" first="Hyla-Louise" last="Kluyts">Hyla-Louise Kluyts</name><name sortKey="Madiba, Thandinkosi E" sort="Madiba, Thandinkosi E" uniqKey="Madiba T" first="Thandinkosi E" last="Madiba">Thandinkosi E. Madiba</name></country><country name="Zimbabwe"><noRegion><name sortKey="Madzimbamuto, Farai D" sort="Madzimbamuto, Farai D" uniqKey="Madzimbamuto F" first="Farai D" last="Madzimbamuto">Farai D. Madzimbamuto</name></noRegion></country><country name="Namibie"><noRegion><name sortKey="Basenero, Apollo" sort="Basenero, Apollo" uniqKey="Basenero A" first="Apollo" last="Basenero">Apollo Basenero</name></noRegion><name sortKey="Gordon, Christina S" sort="Gordon, Christina S" uniqKey="Gordon C" first="Christina S" last="Gordon">Christina S. Gordon</name></country><country name="Mali"><noRegion><name sortKey="Youssouf, Coulibaly" sort="Youssouf, Coulibaly" uniqKey="Youssouf C" first="Coulibaly" last="Youssouf">Coulibaly Youssouf</name></noRegion></country><country name="Madagascar"><noRegion><name sortKey="Rakotoarison, Sylvia R" sort="Rakotoarison, Sylvia R" uniqKey="Rakotoarison S" first="Sylvia R" last="Rakotoarison">Sylvia R. Rakotoarison</name></noRegion></country><country name="Gambie"><noRegion><name sortKey="Samateh, Ahmadou L" sort="Samateh, Ahmadou L" uniqKey="Samateh A" first="Ahmadou L" last="Samateh">Ahmadou L. Samateh</name></noRegion></country><country name="Nigeria"><region name="État d'Oyo"><name sortKey="Omigbodun, Akinyinka O" sort="Omigbodun, Akinyinka O" uniqKey="Omigbodun A" first="Akinyinka O" last="Omigbodun">Akinyinka O. Omigbodun</name></region><name sortKey="Amanor Boadu, Simbo D" sort="Amanor Boadu, Simbo D" uniqKey="Amanor Boadu S" first="Simbo D" last="Amanor-Boadu">Simbo D. Amanor-Boadu</name></country><country name="Ouganda"><noRegion><name sortKey="Tumukunde, Janat T" sort="Tumukunde, Janat T" uniqKey="Tumukunde J" first="Janat T" last="Tumukunde">Janat T. Tumukunde</name></noRegion></country><country name="Canada"><noRegion><name sortKey="Manach, Yannick Le" sort="Manach, Yannick Le" uniqKey="Manach Y" first="Yannick Le" last="Manach">Yannick Le Manach</name></noRegion></country><country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Forget, Patrice" sort="Forget, Patrice" uniqKey="Forget P" first="Patrice" last="Forget">Patrice Forget</name></region></country><country name="Libye"><noRegion><name sortKey="Elkhogia, Abdulaziz M" sort="Elkhogia, Abdulaziz M" uniqKey="Elkhogia A" first="Abdulaziz M" last="Elkhogia">Abdulaziz M. Elkhogia</name></noRegion></country><country name="Algérie"><noRegion><name sortKey="Mehyaoui, Ryad M" sort="Mehyaoui, Ryad M" uniqKey="Mehyaoui R" first="Ryad M" last="Mehyaoui">Ryad M. Mehyaoui</name></noRegion></country><country name="Bénin"><noRegion><name sortKey="Zoumeno, Eugene" sort="Zoumeno, Eugene" uniqKey="Zoumeno E" first="Eugene" last="Zoumeno">Eugene Zoumeno</name></noRegion></country><country name="Burundi"><noRegion><name sortKey="Ndayisaba, Gabriel" sort="Ndayisaba, Gabriel" uniqKey="Ndayisaba G" first="Gabriel" last="Ndayisaba">Gabriel Ndayisaba</name></noRegion></country><country name="Cameroun"><noRegion><name sortKey="Ndasi, Henry" sort="Ndasi, Henry" uniqKey="Ndasi H" first="Henry" last="Ndasi">Henry Ndasi</name></noRegion></country><country name="Kenya"><noRegion><name sortKey="Ndonga, Andrew K N" sort="Ndonga, Andrew K N" uniqKey="Ndonga A" first="Andrew K N" last="Ndonga">Andrew K N. Ndonga</name></noRegion><name sortKey="Ngumi, Zipporah W W" sort="Ngumi, Zipporah W W" uniqKey="Ngumi Z" first="Zipporah W W" last="Ngumi">Zipporah W W. Ngumi</name></country><country name="Zambie"><noRegion><name sortKey="Patel, Ushmah P" sort="Patel, Ushmah P" uniqKey="Patel U" first="Ushmah P" last="Patel">Ushmah P. Patel</name></noRegion></country><country name="Éthiopie"><noRegion><name sortKey="Ashebir, Daniel Zemenfes" sort="Ashebir, Daniel Zemenfes" uniqKey="Ashebir D" first="Daniel Zemenfes" last="Ashebir">Daniel Zemenfes Ashebir</name></noRegion></country><country name="Ghana"><noRegion><name sortKey="Antwi Kusi, Akwasi A K" sort="Antwi Kusi, Akwasi A K" uniqKey="Antwi Kusi A" first="Akwasi A K" last="Antwi-Kusi">Akwasi A K. Antwi-Kusi</name></noRegion></country><country name="Tanzanie"><noRegion><name sortKey="Mbwele, Bernard" sort="Mbwele, Bernard" uniqKey="Mbwele B" first="Bernard" last="Mbwele">Bernard Mbwele</name></noRegion></country><country name="Togo"><noRegion><name sortKey="Sama, Hamza Doles" sort="Sama, Hamza Doles" uniqKey="Sama H" first="Hamza Doles" last="Sama">Hamza Doles Sama</name></noRegion></country><country name="Égypte"><noRegion><name sortKey="Elfiky, Mahmoud" sort="Elfiky, Mahmoud" uniqKey="Elfiky M" first="Mahmoud" last="Elfiky">Mahmoud Elfiky</name></noRegion><name sortKey="Fawzy, Maher A" sort="Fawzy, Maher A" uniqKey="Fawzy M" first="Maher A" last="Fawzy">Maher A. Fawzy</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Pearse, Rupert M" sort="Pearse, Rupert M" uniqKey="Pearse R" first="Rupert M" last="Pearse">Rupert M. Pearse</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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