Population health data in KSA: Status, challenges, and opportunities

Factors associated with 30-day mortality and morbidity in patients undergoing emergency colorectal surgery

BACKGROUND

The 30-day period following emergency colorectal surgery (ECRS) is associated with high mortality and morbidity. There is a lack of data assessing factors associated with outcomes of ECRS in the Saudi population.

OBJECTIVES

Assess factors associated with 30-day postoperative mortality and complications following ECRS.

DESIGN

Retrospective cohort study.

SETTING

Single tertiary care center, Riyadh, Saudi Arabia.

PATIENTS AND METHODS

Demographic characteristics (age, sex, diagnosis, American Society of Anesthesiologists classification, pre-operative septic state, smoking, and comorbidities), operative characteristics (urgency, diverting ostomy, and procedure performed), and postoperative characteristics (length of stay, 30-day mortality, intensive care unit [ICU] admission, ICU length of stay, surgical site infection [SSI], readmission, reoperation, and complications) were collected from electronic medical records. Univariate logistic regression was used to evaluate association with the outcome measures (30-day mortality and postoperative complications). Multivariate logistic regression was applied to evaluate independent variables.

MAIN OUTCOME MEASURE

Thirty-day postoperative mortality and morbidity.

SAMPLE SIZE

241 patients.

RESULTS

Among 241 patients, 145 (60.2%) were men, and 80 (33.2%) patients were between 50-64 years of age. The most common indication for surgery was malignancy 138 (57%). The overall complication rate was 26.6% and the 30-day mortality rate was 11.2%. Left hemicolectomy was the most commonly performed procedure, performed in 69 (28.6%) patients. Patients between the age of 65-74 had an increased odds of death within 30 days (OR 5.25 [95% CI 1.03-26.5]) on univariate analysis. Preoperative sepsis was associated with a fourfold increase in the likelihood of 30-day mortality (OR 4.44, 95% CI 1.21-16.24, P=.024) on multivariate analysis. The likelihood of hospital re-admission increased by fivefold in patients who developed a postoperative complication (OR 5.33, 95% CI 1.30-21.78, P=.02).

CONCLUSION

Preoperative sepsis was independently associated with 30-day mortality in patients undergoing ECRS, while the likelihood of hospital readmission increased in patients with postoperative complications. Expeditious control of sepsis in the emergency surgical setting by both surgical and medical interventions may reduce the likelihood of postoperative mortality. Establishing discharge protocols for postoperative ECRS patients is advocated.

LIMITATIONS

Retrospective design, small sample size, and single setting.

Compliance of Healthcare Providers With the Notifiable Diseases Surveillance System in Riyadh, Saudi Arabia

Introduction Though reporting notifiable diseases is obligatory in Saudi Arabia, and the Saudi Ministry of Health establishes guidelines, there are concerns about healthcare providers' compliance, and studies evaluating the notifiable diseases surveillance system (NDSS) are lacking, underlying the urgent need to assess the compliance of healthcare providers with the NDSS in Saudi Arabia. Methods This cross-sectional study involved doctors, nurses, and epidemiologists working in healthcare facilities in Riyadh, Saudi Arabia. The data collection was done using a self-administered questionnaire. SPSS version 27 software (IBM Corp., Armonk, NY) was used for statistical analyses. Results We included 420 participants enrolled in our study, and 63.1% were female. Of 51.4% of participants who worked in private healthcare facilities, 75.7% of them were nurses, while the majority of those working in governmental facilities were doctors (69.1%). The age range was 20-62 years, and the dominant age group was 31-40 years (63.8%). Most participants had no training in epidemiology (79.7%) and of those trained, 64% had a certificate training level. Most notifiable diseases worked were detected in governmental health facilities (35.6% vs. 18.8%). Of those who identified notifiable diseases, 84.3% notified them. COVID-19, measles, and hepatitis A, B, and C were the most notified diseases. The lack of knowledge of the notification system was the most common barrier to the notification among 81 nurses, 39 doctors, and one epidemiologist. There was a significant relationship between being a doctor in the governmental institution and notification timeline (p = 0.024). Conclusion This study showed that identifying notifiable diseases was poor despite good compliance among those who identified them. This study showed the lack of proper training of participants, explaining poor knowledge. The findings highlight the differences in notification practices between private and governmental facilities and the need for educational interventions to tackle the knowledge barrier reported.

Effectiveness of Interventions Promoting Physical Activity and Reducing Sedentary Behavior in Community-Dwelling Older Adults: An Umbrella Review With Application to Saudi Arabia

BACKGROUND

As Saudi Arabia is expected to face population aging in the future, the burden of diseases arising from inadequate physical activity (PA) and excess sedentary behavior (SB) may subsequently increase without successful interventions. The present study critically reviews the global literature on the effectiveness of PA interventions targeting community-dwelling older adults to draw on lessons and applications for future interventions in Saudi Arabia.

METHODS

This umbrella review of systematic reviews included interventions designed to increase PA and/or reduce SB in community-dwelling older adults. We conducted searches in July 2022 in two electronic databases-PubMed and Embase-and identified relevant peer-reviewed systematic reviews in English.

RESULTS

Fifteen systematic reviews focusing on community-dwelling older adults were included. Several reviews reported that PA- or SB-based interventions, including eHealth interventions (such as automated advice, tele-counseling, digital PA coaching, automated PA tracking and feedback, online resources, online social support, and video demonstrations), mHealth interventions, and non-eHealth interventions (such as goal setting, individualized feedback, motivational sessions, phone calls, face-to-face education, counseling, supervised exercise sessions, sending educational materials to participants' homes, music, and social marketing programs), were effective in the short term (e.g., ≤ 3 months) but with wide heterogeneity in findings and methodologies. There were limited studies on PA- and SB-based interventions that could be effective for one year or more after the intervention. Most reviews were heavily skewed toward studies carried out in Western communities, limiting their generalizability to Saudi Arabia and other parts of the world.

CONCLUSION

There is evidence that some PA and SB interventions may be effective in the short term, but high-quality evidence regarding long-term effects is lacking. The cultural, climate, and environmental barriers related to PA and SB in Saudi Arabia require an innovative approach and research to evaluate such interventions in older individuals in the long term.