Thursday, January 04, 2018

Surgical Care?

Patients undergoing surgery in Africa are more than twice as likely to die following an operation than the global average, despite generally being younger, healthier and the surgery they are undergoing being more minor, research has revealed.

The study of 11,422 adult patients at 247 hospitals spread over 25 countries – including Ethiopia, Egypt, Nigeria and Zambia, revealed that just over 18% of in-patients developed complications following surgery, while 1% of elective in-patients died in hospital within 30 days of their operation – twice the global average. 

Prof Bruce Biccard, a co-author of the latest study from the University of Cape Town, said that one of the major problems is likely to be an insufficient number of medical staff, resulting in difficulties in spotting or tackling complications following operations. “The reason that people do so terribly in Africa from a surgical point of view is that there are just no human resources,” he said.  The findings are probably a reflection of a scanty workforce, limited numbers of hospital beds, and poor systems to check up on patients follow surgery, noting that there are only about 0.7 specialist surgeons, obstetricians and anaesthesiologists per 100,000 population. The recommended figure to decrease the risk of death following surgery is 20–40 such specialists per 100,000 population. “There is no way we are going to be able to train enough physicians to fill this deficit in human resources,” said Biccard

The results reveal that 2.1% of those who underwent any surgery, and 1% of those who had elective surgery, died in hospital within 30 days of their operation. Only a minority of deaths occurred on the day of the operation itself.
Just over 18% of all patients developed complications, ranging from stroke to pneumonia, almost one in 10 of whom died. “It is likely that many of these deaths were preventable,” the authors note.
The study also revealed that the number of operations across the continent was very low and fewer than 43% of surgeries in Africa were elective, with the majority of patients instead undergoing urgent or emergency operations. That highlights another problem: that many individuals who need surgery might not have access to it. “The real sad thing is that there is a lot of surgery obviously that is not happening,” he said. “That is probably a huge killer in Africa,” he added.
Dr David Walker, a consultant in anaesthesia and critical care medicine at University College London Hospitals, who was not involved in the study, also said the latest study suggests that poor access to timely surgery is a “forgotten epidemic” in Africa.

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