G. Miguel1, R. Jean Paul3, J. Rickard4, U. Nathalie1, M. Emmanuel1, N. Venuste3, U. Patrick3, M. Christophe2 1CHUK, Kigali, KIGALI, Rwanda 2Kibagabaga Teaching Hospital, Kigali, KIGALI, Rwanda 3CHUB, HUYE, SOUTH, Rwanda 4University Of Minnesota, ACS, Minneapolis, MN, USA
Introduction: Rwanda, like other low- and middle-income countries, has large unmet surgical needs. As attention is focused on increasing surgical volume, efforts must be directed towards ensuring quality of care. The perioperative mortality rate is one metric to assess surgical quality. The main objective of the study was to document the incidence of perioperative mortality in surgical patients in Rwanda.
Methods: This was a 14-day nationwide, multicenter prospective observational study of patients undergoing surgery between July 18-31, 2020. Patients were followed for in-hospital complications and mortality. We collected data on demographics, clinical data, and outcomes. We analyzed factors associated with mortality using the chi-square test.
Results:
There were 1458 patients enrolled at 47 different hospitals in the country, representing 44 public and 3 private hospitals. The mean age was 31 years (Standard Deviation: 16.6) and 480 (33%) were male. Most patients (n= 88, 6%) did not have a comorbidity. 46(3%) patients were in the American Society of Anesthesiologists (ASA) III and IV. Emergency operations accounted for 700 (48%) cases. The most common operations were performed for obstetrics and gynecology (n=697, 48%). General surgery was the second most common specialty accounting for 262 (18%) operations. 23 patients (1.6%) were admitted to the Intensive Care Unit (ICU). The median length of hospital stay was 3 (Interquartile Range: 2,4) days.
Overall, 54 (4%) patients had a postoperative complication, and the perioperative mortality rate was 0.8%. Mortality was associated with emergency operations (P=0.002), ASA score (P<0.001), and ICU admission (P<0.001). There was no association between mortality and gender, age, or specialty.
Conclusion: Overall the perioperative mortality and complication rates in Rwanda are low. As Rwanda continues to scale up surgery to address unmet surgical needs, additional metrics could be used to monitor and ensure the quality of surgical care. Routine recording of the volume of surgical procedures and their outcomes will help in implementing measures to optimize patient outcomes.