Outcomes of open abdominal surgery at a single-centre tertiary referral hospital in Tanzania: a prospective, observational, single-arm cohort study
Nathan Brand, Larry Akoko, Emmanuel Obedi, Ally Mwanga, Godfrey Sama Philipo, Charles Komba, Marissa BoeckObjectives
To assess the outcomes of patients undergoing open abdominal surgery at a National Referral Hospital in Tanzania.
Design
A prospective, observational, single-arm cohort study.
Setting
Dar es Salaam, Tanzania.
Participants
Patients who underwent open abdominal surgery between August 2022 and July 2023 were included. Patients were enrolled if they provided informed consent to participate and were ≥18 years of age. Patients were excluded if they were lost to follow-up, were admitted outside the department of surgery or were still admitted since the index surgery at the end of the study.
Main outcome measures
The primary outcome was a composite measurement of mortality that includes patients who died during the index admission and those who died up to 30 days postdischarge. Secondary outcomes included surgical complications, unplanned readmissions, economic burden and functional outcomes. Clinically relevant factors identified a priori and with a p value of ≤0.2 in the univariable model were tested in a multivariable logistic regression to identify independent risk factors for composite mortality, with backward stepwise elimination using a statistical significance set at a p value <0.05 and 95% CI not including 1.0.
Results
Of 626 patients who had an open abdominal surgery, 555 (88.7%) met the inclusion criteria, of which 120 (21.6%) died. Of the deaths, 61 (51%) occurred during the index admission, 48 (40%) outside the hospital and 11 (9%) following unplanned readmission. Among the surviving 435 (78%) patients who participated in the 30-day follow-up, those without insurance were less likely to return to work (7.3% vs 16% insured) and had higher out-of-pocket expenses ($321 vs $82 insured).
Conclusions
Open abdominal surgery carries a composite mortality rate of 22% with almost half of deaths occurring after index hospital discharge. These findings underscore the need for routine follow-up, early complication identification and management and universal health coverage to improve outcomes, and reduce financial hardships.