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Intraoperative Mortality in Malawi.

Meghan Prin1, Stephanie Pan2, Janey Phelps3

  • 1From the Department of Anesthesiology and Critical Care, Columbia University College of Physicians and Surgeons, New York, New York.

Anesthesia and Analgesia
|May 17, 2019
PubMed
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Intraoperative mortality in Malawi remains high, with no significant improvement observed between 2004-2006 and 2015-2016. Emergency surgeries and higher American Society of Anesthesiologists physical status scores were linked to increased risk.

Area of Science:

  • Global Health
  • Surgical Outcomes
  • Low-Resource Healthcare

Background:

  • Surgical care is vital for population health, yet monitoring surgical delivery in low-resource settings is challenging.
  • Benchmarking progress in surgical care requires robust metrics, especially in developing nations.
  • Intraoperative mortality is a critical indicator of surgical care quality.

Purpose of the Study:

  • To measure intraoperative mortality at a Malawian Central Referral Hospital.
  • To assess changes in intraoperative mortality over two distinct time periods.
  • To identify factors associated with intraoperative mortality in this setting.

Main Methods:

  • Retrospective cohort study at Kamuzu Central Hospital, Malawi.
  • Prospective data collection on consecutive operative cases across two periods: 2004-2006 and 2015-2016.

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  • Inverse probability of treatment weighting and multivariable logistic regression analyzed intraoperative mortality trends and associated factors.

    • Main Results:

    • A total of 21,090 surgeries were analyzed.
    • Intraoperative mortality rates were 57/100,000 (early cohort) and 133/100,000 (late cohort), with an overall rate of 76/100,000.
    • No significant change in intraoperative mortality over time was detected (OR, 1.6; P = .08). Factors associated with mortality included ASA physical status III/IV (OR, 4.4) and emergency surgery (OR, 7.7).

    Conclusions:

    • Intraoperative mortality in this Malawian hospital is high and has not improved.
    • Urgent improvements in perioperative care safety and quality are needed in developing countries.
    • Integrating perioperative care into global health initiatives is essential.