The Ethiopian Surgical Outcome Study (Ethio-SOS): a 7-day multicentre national prospective observational cohort study

Safe surgical care is a cost-effective intervention for addressing a wide range of conditions, yet postoperative complications remain a leading global cause of disability, mortality and economic loss, disproportionately affecting low- and middle-income countries. This study aims to generate robust epidemiological data on postoperative outcomes for surgical patients in Ethiopia.

This 7 day national observational cohort study included adult patients undergoing elective and non-elective surgeries, using a convenience sampling method to recruit as many hospital sites as possible from all regions of Ethiopia. The primary outcomes measured were 7 day in-hospital mortality and postoperative complications. Statistical analysis included descriptive statistics and logistic regression models to identify risk factors for mortality and complications.

A total of 4412 surgical patients across 46 Ethiopian hospitals were included in this study. The median patient age was 30 years (IQR: 25-42), with a predominance of female participants 2772/4412 (62.8%) and American Society of Anaesthesiologists (ASA) classification class I-II classifications. The overall complication rate was 19.8% (873/4412), with 4.2% (184/4412) experiencing severe complications (Clavien-Dindo grades III-IV) necessitating reoperation. The overall mortality rate was 0.4% (17/4412), with a median age at death of 40 years (IQR=29-49). Our findings suggest that the key drivers of perioperative mortality and postoperative complications were higher ASA class, comorbidities, cancer surgery, infections and emergency surgical procedures.

One in five surgical patients in Ethiopia experiences postoperative complications and a high rate of reoperation, despite exhibiting a low-risk profile, young age and a low rate of high-risk surgical procedures. This suggests a need for more evidence-based interventions to strengthen the foundations, care processes and quality of the surgical system to achieve safe and effective care and improve overall surgical outcomes in the country.