Abstract

 ABSTRACT

Background:  Surgical outomes  study for  individual  nations remains important  because of international differences in  patterns  of surgical  disease. We aimed to  contribute  to  data  on post-operative complications,  critical care admissions and  mortality  following  elective  surgery In  Nigeria  and  also  validate  the African  Surgical Outcomes Study(ASOS)  surgical  risk calculator in  our adult  patient cohort.

Materials and methods:  We  conducted  a 7 -day,  national  prospective observational cohort study   in  consented consecutive patients  undergoing  elective   surgery   with   a  planned  overnight hnspital stay  following elective surgery during a seven-day study period.  The outcome measures were  in-hospital postoperative complications, critical  care admissions and  in-hospital  mortality censored at  30 days.  Also,  we  identified various factors which  significantly contributed to higher ASOS surgical  risk score.  External  validation was performed using  area  under the receiver operating characteristic  curve  (ROC)  for discrimination  assessment and  Hosmer-Lemeshew test  for calibration.

Results:  A total  of 1,425  patients  from  79  hospitals participated  in  the study. Postoperative complications occurred in 26'1(]8.5%, 95% CI 16.6-20.6), 20(7.6%)  of whom were admitted  into  the ICU and 16(6.0%)  did not survive. Total ICU admission was 57  (4%), with mortality rate of 23.5% following planned admission and overall ln-hospital  death was  22(1.5%,  95%  Cl 0.9-2.2).  All  prognostic  factors  in  the ASOS risk  calculator  were slgnificantly associated with higher ASOS score and  the scoring system showed moderate discrimination (0·73, 95% Cl 0.62-0.83).  Besmer-Lemeshow  X,2  test  revealed  scale was well  calillfled  in  the  validation  cohort. Condusiori:  NiSOS  validates  the  findings of ASOS and the ability of the  ASOS surgical risk calculator  to predict risk of developing severe postoperative complications and mortality.  We identified failure-to-rescue as a problem in Nigeria.  Furthermore,  this study has provided policy  makers with  benchmarks that can be used to monitor

programmes aimed al reducing the morbidity and mortality after elective surgery.  We recommend the adoptionof the ASOS surgical risk  calculator  as a tool  for risk stratification  preoperatively for elective surgery.