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Noncardiac thoracic surgery in Abidjan, from 1977 to 2015
Yves Tanauh1, Flavien Kendja1, Hervé Yangni-Angate2
1Department of Thoracic Surgery, Heart Institute of Abidjan, Abidjan, Côte d'Ivoire.
Insights
Noncardiac thoracic surgery in Abidjan shows a rise in trauma cases and a decrease in mortality over 39 years. Despite challenges in access to care, outcomes remain reasonable.
Area of Science:
- Thoracic Surgery
- Surgical Outcomes
- Public Health
Background:
- Analysis of noncardiac thoracic operations conducted at the Cardiology Institute of Abidjan.
- Study spans a 39-year period, from 1977 to 2015.
Purpose of the Study:
- To report and analyze trends in noncardiac thoracic surgery over nearly four decades.
- To assess changes in patient demographics, pathologies, surgical procedures, and outcomes.
Main Methods:
- Retrospective, descriptive study of 2014 patient records from 1977-2015.
- Data divided into three 13-year periods (P1: 1977-1989, P2: 1990-2002, P3: 2003-2015).
- Analysis of age, sex, pathologies, operations, complications, and mortality using statistical tests.
Main Results:
- Average patient age decreased from 35 (P1) to 31.6 (P3).
- Thoracic trauma cases significantly increased, becoming the predominant pathology in P3 (56.9%).
- Overall mortality decreased from 5.3% (P1) to 3.4% (P3), despite an increase in postoperative empyema.
Conclusions:
- Noncardiac thoracic surgery addresses infections, tuberculosis sequelae, tumors, and trauma, with trauma increasing due to conflict.
- Access to care is limited by economic status and lack of health insurance, leading to late-stage diagnoses.
- Overall surgical mortality is considered reasonable despite access challenges.
Background:
To report and analyze noncardiac thoracic operations performed at the Cardiology Institute of Abidjan (Institut de Cardiologie d'Abidjan) from 1977 to 2015.
Methods:
This is a retrospective and descriptive study covering 39 years, from 1977 to 2015. This study period was divided into three periods of 13 years each: P1 from 1977 to 1989, P2 from 1990 to 2002 and P3 from 2003 to 2015. Medical records of 2014 operated patients were analyzed: 414 patients for P1, 464 patients for P2, 1,136 patients for P3. The records destroyed in a fire in 1997 were not included in the study. The age, sex, pathologies, types of operations, post-operative complications and mortality were analyzed with usual statistical tests.
Results:
The average age varied from 35 years in P1 to 31.6 years in P3. Men predominate in all periods. Distribution of important groups of pathologies observed varies significantly over the three periods; In particular, we note an increase in trauma cases (tripling between P1 and P2, 140% between P2 and P3), and a decrease in tumors percentages, and infections and pulmonary sequelae of tuberculosis. Surgical management of thoracic trauma has increased (56.9% in P3) followed by the pleural surgery (21.3%) and pulmonary resections (13.9%). Persistent air leak >7 days was the predominant complication over the three periods. Postoperative empyema increased in P3 (14.7%). Close chest drainage-irrigation is the most frequent procedure performed to sterilize a major complication like postoperative empyema without bronchopleural fistula. Overall mortality decreased from 5.3% in P1 to 3.4% in P3.
Conclusions:
Noncardiac thoracic surgery operations still concern infections, pulmonary sequelae of tuberculosis, thoracic tumors and many more thoracic trauma caused by current armed conflicts and terrorist attacks. But access to thoracic surgical care remains difficult for our population secondary to low economic status, and lack of a health insurance system. Therefore surgical consultation is often obtained at a very advanced stage of the disease. Nevertheless overall mortality observed in the practice of this surgery is reasonable.
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