Death Rates After Surgery Twice as High in African Hospitals
Patients in African hospitals are twice as likely to die after surgery than the global average, according to a new study.
Although African patients were younger and at lower risk than average, 1 percent died of complications after elective surgery, compared to a 0.5 percent death rate worldwide.
“It’s really concerning when you see how high the mortality is, considering that the patients are generally fit and they’re having a lot more minor surgeries,” lead author Bruce Biccard of the University of Cape Town said.
Workforce and resource shortages across the continent are likely a major factor, the authors of the study write in the journal The Lancet.
The group of more than 30 African researchers took a one-week snapshot of surgeries at 247 hospitals in 25 African countries, from Algeria to Madagascar.
The study found a severe shortage of African surgeons, obstetricians and anesthesiologists. Previous research has found that fewer patients die after surgery when there are 20 to 40 specialists per 100,000 population. Across the continent, this study found an average of less than one per 100,000.
In addition to the high death rate, “the most alarming finding was how few people actually received surgery,” noted a commentary accompanying the study. An expert panel has estimated that 5 percent of the population needs surgery in a year. African hospitals on average performed less than one-twentieth of that figure.
It noted that patients were receiving surgery later in the course of their diseases. Nearly 60 percent of the operations were urgent or emergency procedures, compared with about a quarter in high-income countries.
Most of the patients who died did not do so on the operating table, but in the days following surgery.
“We’re actually failing to recognize patients who are having complications in the post-op period,” study author Biccard said. “So a minor complication becomes a major complication.”
That offers an opportunity for improvement, Biccard noted. Since increasing the number of doctors is unlikely in the short term, his group is working on a method “that will tell us before surgery which patients we think are going to get into trouble.”
His group is planning a study in 2019 to see if they can reduce patient deaths by focusing limited resources on patients at the highest risk.