SAMJ: South African Medical Journal
On-line version ISSN 2078-5135
Print version ISSN 0256-9574
BICCARD, B M and MADIBA, T E. The South African Surgical Outcomes Study: A 7-day prospective observational cohort study. SAMJ, S. Afr. med. j. [online]. 2015, vol.105, n.6, pp.465-475. ISSN 2078-5135. http://dx.doi.org/10.7196/SAMJ.9435.
BACKGROUND: Non-cardiac surgical morbidity and mortality is a major global public health burden. Sub-Saharan African perioperative outcome data are scarce. South Africa (SA) faces a unique public health challenge, engulfed as it is by four simultaneous epidemics: (i) poverty-related diseases; (ii) non-communicable diseases; (iii) HIV and related diseases; and (iv) injury and violence. Understanding the effects of these epidemics on perioperative outcomes may provide an important perspective on the surgical health of the country. OBJECTIVES: To investigate the perioperative mortality and need for critical care admission in patients undergoing inpatient non-cardiac surgery in SA. METHODS: A 7-day national, multicentre, prospective, observational cohort study of all patients >16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 public sector, government-funded hospitals in SA. RESULTS: The study included 3 927/4 021 eligible patients (97.7%) recruited, with 45/50 hospitals (90.0%) submitting data that described all eligible patients. Crude in-hospital mortality was 123/3 927 (3.1%; 95% confidence interval (CI) 2.6 - 3.7). The rate of postoperative admission to critical care units was 255/3 927 (6.5%; 95% CI 5.7 - 7.3), with 43.5% of admissions being unplanned. Of the surgical procedures 2 120/3 915 (54.2%) were urgent or emergency ones, with a population-attributable risk for mortality of 25.5% (95% CI 5.1 -55.8) and a risk of admission to critical care of 23.7% (95% CI 4.7 - 51.4). CONCLUSIONS: Most patients in SA's public sector hospitals undergo urgent and emergency surgery, which is strongly associated with mortality and unplanned critical care admissions. Non-communicable diseases have a larger proportional contribution to mortality than infections and injuries. However, the most common comorbidity, HIV infection, was not associated with in-hospital mortality. The study was registered on ClinicalTrials.gov (NCT02141867).