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Chandiwana N, Venter W, Manne-Goehler J, Wade A, Le Roux C, Mbalati N, Grimbeek A, Kruger P, Montsho E, Zimela Z, Yawa A, Tshabalala S, Rambau N, Mpofu N, Stevenson S, McNulty B, Ntusi N, Pillay Y, Dave J, Murphy A, Goldstein S, Hfman K, Mahomedy S, Thomas E, Mrara B, Wing J, Lubbe J, Koto Z, Conradie-Smit M, Wharton S, May W, Marr I, Kaplan H, Forgan M, Alexander G, Turner J, Fourie VR, Hellig J, Banks M, Ragsdale K, Noeth M, Mohamed F, Myer L, Lebina L, Maswime S, Moosa Y, Thomas S, Mbelle M, Sinxadi P, Bekker LG, Bhana S, Fabian J, Decloedt E, Bayat Z, Daya R, Bobat B, Storie F, Goedecke J, Kahn K, Tollman S, Mansfield B, Siedner M, Marconi V, Mody A, Mtshali N, Geng E, Srinivasa S, Ali M, Lalla-Edwards S, Bentley A, Wolvaardt G, Hill A, Nel J. Obesity is South Africa's new HIV epidemic. S Afr Med J 2024; 114:e1927. [PMID: 38525565 DOI: 10.7196/samj.2024.v114i3.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Indexed: 03/26/2024] Open
Affiliation(s)
| | - Willem Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand.
| | | | - Alisha Wade
- Research in Metabolism and Endocrinology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand.
| | - Carel Le Roux
- Diabetes Complications Research Centre, University College Dublin; Chemical Pathology, University of Pretoria.
| | | | | | | | | | | | - Anele Yawa
- General Secretary, Treatment Action Campaign .
| | | | | | - Ngqabutho Mpofu
- Communications, and Research Manager, Treatment Action Campaign .
| | | | | | - Ntobeko Ntusi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital; University of Cape Town/SAMRC Extramural Research Unit on Intersection of Noncommunicable Diseases and Infectious Diseases; ARUA/Guild Cluster of Research Excellence on Noncommunicable Diseases and Associated Multimorbidity.
| | - Yogan Pillay
- Director, HIV & TB Delivery, Bill and Melinda Gates Foundation, Pretoria; Department of Global Health, Stellenbosch University.
| | - Joel Dave
- Division of Endocrinology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town.
| | | | - Sue Goldstein
- SAMRC/Wits Centre for Health Economics and Decision Science; PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Karen Hfman
- SAMRC/Wits Centre for Health Economics and Decision Science; PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Sameera Mahomedy
- AMRC/Wits Centre for Health Economics and Decision Science; PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Elizabeth Thomas
- SAMRC/ Wits Centre for Health Economics and Decision Science; PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Busi Mrara
- Professor and Head of Anaesthesiology and Critical Care, Walter Sisulu University.
| | - Jeff Wing
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand.
| | - Jeanne Lubbe
- Head, Upper Gastrointestinal Surgery, Tygerberg Hospital and Stellenbosch University; President, South African Metabolic Medicine and Surgery Society.
| | - Zack Koto
- Chair, Department of Surgery, Dr George Mukhari Academic Hospital and Sefako Makgatho Health Sciences University; President, College of Surgeons of South Africa; Senior Vice-President, Colleges of Medicine of South Africa, President, Association of Surgeons of South Africa.
| | | | - Sean Wharton
- McMaster University, York University, and Wharton Weight Management Clinic.
| | | | | | | | | | | | - John Turner
- Honorary Senior Specialist Groote Schuur Hospital and the University of Cape Town, Cape Town Bariatric Clinic .
| | | | | | | | | | | | - Farzahna Mohamed
- Acting Clinical Head of Endocrinology, Charlotte Maxeke Johannesburg Academic Hospital and Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand.
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Cape Town.
| | | | - Salome Maswime
- Global Surgery Division, Faculty of Health Sciences, University of Cape Town.
| | - Yunus Moosa
- Southern African HIV Clinicians Society; Department of Infectious Diseases, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal.
| | - Sumy Thomas
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand.
| | - Mzamo Mbelle
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital; Institute of Liver Studies, King's College Hospital.
| | - Phumla Sinxadi
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town.
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town.
| | - Sindeep Bhana
- Honorary lecturer, Chris Hani Baragwanath Academic Hospital and Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand.
| | - June Fabian
- Wits Donald Gordon Medical Centre, Faculty of Health Sciences, University of the Witwatersrand.
| | - Eric Decloedt
- Head, Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital.
| | - Zaheer Bayat
- Academic Head of Endocrinology, University of the Witwatersrand; Clinical Head of Medicine, Helen Joseph Hospital.
| | - Reyna Daya
- Clinical Head of Endocrinology, Helen Joseph Hospital; Chair, Society for Endocrinology, Metabolism and Diabetes of South Africa.
| | - Bilal Bobat
- Wits Donald Gordon Medical Centre, Faculty of Health Sciences, University of the Witwatersrand.
| | | | - Julia Goedecke
- Biomedical Research and Innovation Platform, South African Medical Research Council.
| | - Kathleen Kahn
- SAMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Stephen Tollman
- SAMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Brett Mansfield
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand.
| | - Mark Siedner
- Africa Health Research Institute, Harvard Medical School.
| | - Vincent Marconi
- Division of Infectious Diseases and Department of Global Health, Emory University School of Medicine and Rollins School of Public Health.
| | - Aaloke Mody
- Division of Infectious Diseases, Department of Medicine, and Center for Dissemination and Implementation, Institute for Public Health, Washington University.
| | | | - Elvin Geng
- Division of Infectious Diseases, Department of Medicine, and Center for Dissemination and Implementation, Institute for Public Health, Washington University.
| | - Suman Srinivasa
- Division of Endocrinology, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School.
| | - Mohammed Ali
- Department of Family and Preventive Medicine, School of Medicine, and Hubert Department of Global Health, Rollins School of Public Health, Emory University.
| | | | - Alison Bentley
- Restonic Ezintsha sleep clinic, South African Society for Sleep and Health.
| | | | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool.
| | - Jeremy Nel
- Division of Infectious Diseases, Department of Medicine, University of the Witwatersrand.
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2
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Nejthardt MB, Alexandris P, Bechan S, Bijli MFA, Chetty S, Dippenaar JM, Gibbs M, Johnson M, Kluyts H, Llewellyn R, Motiang M, Mogane P, Motshabi P, Mrara B, Roodt F, Singh U, Spijkerman S, Turton E, Van der Westhuizen J, Biccard B. The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus. S Afr Med J 2024; 114:e1306. [PMID: 38525581 DOI: 10.7196/samj.2024.v114i2.1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Low- and middle-income countries have a critical shortage of specialist anaesthetists. Most patients arriving for surgery are of low perioperative risk. Without immediate access to preoperative specialist care, an appropriate interim strategy may be to ensure that only high-risk patients are seen preoperatively by a specialist. Matching human resources to the burden of disease with a nurse-administered pre-operative screening tool to identify high-risk patients who might benefit from specialist review prior to the day of surgery may be an effective strategy. OBJECTIVE To develop a nurse-administered preoperative anaesthesia screening tool to identify patients who would most likely benefit from a specialist review before the day of surgery, and those patients who could safely be seen by the anaesthetist on the day of surgery. This would ensure adequate time for optimisation of high-risk patients preoperatively and limit avoidable day-of-surgery cancellations. METHODS A systematic review was conducted to identify preoperative screening questions for use in a three-round Delphi consensus process. A panel of 16 experienced full-time clinical anaesthetists representing all university-affiliated anaesthesia departments in South Africa participated to define a nurses' screening tool for preoperative assessment. RESULTS Ninety-eight studies were identified, which generated 79 questions. An additional 14 items identified by the facilitators were added to create a list of 93 questions for the first round. The final screening tool consisted of 81 questions, of which 37 were deemed critical to identify patients who should be seen by a specialist prior to the day of surgery. CONCLUSION A structured nurse-administered preoperative screening tool is proposed to identify high-risk patients who are likely to benefit from a timely preoperative specialist anaesthetist review to avoid cancellation on the day of surgery.
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Affiliation(s)
- M B Nejthardt
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa.
| | - P Alexandris
- Department of Anaesthesia, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa.
| | - S Bechan
- Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, Albert Luthuli Academic Hospital, Durban, South Africa.
| | - M F A Bijli
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - S Chetty
- Department of Anaesthesia and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - J M Dippenaar
- Department of Anaesthesiology, Steve Biko Academic Hospital, University of Pretoria, South Africa.
| | - M Gibbs
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa.
| | - M Johnson
- Department of Anaesthesia and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - H Kluyts
- Department of Anaesthesiology and Critical Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
| | - R Llewellyn
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa.
| | - M Motiang
- Department of Anaesthesiology and Critical Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
| | - P Mogane
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Anaesthesia, Chris Hani Baragwanath Hospital, Soweto, South Africa.
| | - P Motshabi
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Anaesthesia, Charlotte Maxeke Hospital, Johannesburg, South Africa.
| | - B Mrara
- Department of Anaesthesia and Critical Care, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa.
| | - F Roodt
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; George Provincial Hospital, George, South Africa.
| | - U Singh
- Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, Albert Luthuli Academic Hospital, Durban, South Africa.
| | - S Spijkerman
- Department of Anaesthesiology, Steve Biko Academic Hospital, University of Pretoria, South Africa.
| | - E Turton
- Department of Anaesthesia, University of the Free State, Universitas Hospital, Bloemfontein, South Africa.
| | - J Van der Westhuizen
- Department of Anaesthesia, University of the Free State, Universitas Hospital, Bloemfontein, South Africa.
| | - B Biccard
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa.
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3
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Maasdorp SD, Paruk F, de Vasconcellos K, Grion C, Joubert I, Joynt GM, Kalafatis N, Lapinsky SE, Lipman J, Malbrain MLNG, Mrara B, Richards GA, Spruyt MGL, van der Merwe E, Vincent JL, van der Merwe LJ. Core competencies in critical care for general medical practitioners in South Africa: A Delphi study. South Afr J Crit Care 2023; 39:e1261. [PMID: 38357694 PMCID: PMC10866206 DOI: 10.7196/sajcc.2023.v39i3.1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 02/16/2024] Open
Abstract
Background Despite a high burden of disease that requires critical care services, there are a limited number of intensivists in South Africa (SA). Medical practitioners at district and regional public sector hospitals frequently manage critically ill patients in the absence of intensivists, despite these medical practitioners having had minimal exposure to critical care during their undergraduate training. Objectives To identify core competencies in critical care for medical practitioners who provide critical care services at public sector hospitals in SA where intensivists are not available to direct patient management. Methods A preliminary list of core competencies in critical care was compiled. Thereafter, 13 national and international experts were requested to achieve consensus on a final list of core competencies that are required for critical care by medical practitioners, using a modified Delphi process. Results A final list of 153 core competencies in critical care was identified. Conclusion The core competencies identified by this study could assist in developing training programmes for medical practitioners to improve the quality of critical care services provided at district and regional hospitals in SA. Contribution of the study The study provides consensus on a list of core competencies in critical care that non-intensivist medical practitioners managing critically ill patients in healthcare settings in South Africa, especially where intensivists are not readily available, should have. The list can form the core content of training programmes aimed at improving critical care competence of general medical practitioners, and in this way hopefully improve the overall outcomes of critically ill patients in South Africa.
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Affiliation(s)
- S D Maasdorp
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - F Paruk
- Department of Critical Care, Faculty of Health Sciences, University of Pretoria, South Africa
| | - K de Vasconcellos
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - C Grion
- Department of Clinical Medical, Hospital Universitári, Universidade Estadual de Londrina, Brazil
| | - I Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - G M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, China
| | - N Kalafatis
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - S E Lapinsky
- Department of Critical Care, Faculty of Medicine, University of Toronto, Canada
| | - J Lipman
- Jamieson Trauma Institute, Royal Brisbane and Women’s Hospital, University of Queensland, Brisbane, Australia; and Nimes University Hospital, University of
Montpellier, Nimes, France
| | - M L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Lublin, Poland
| | - B Mrara
- Department of Anaesthesia, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - G A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M G L Spruyt
- Division of Critical Care, Department of Surgery, University of the Free State, Bloemfontein, South Africa
| | - E van der Merwe
- Department of Critical Care, Livingstone Hospital, Gqeberha, South Africa
| | - J L Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Belgium
| | - L J van der Merwe
- Division of Health Sciences Education, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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4
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Mrara B. Burnout: is all the talk of burnout causing us to burn out. South Afr J Anaesth Analg 2020. [DOI: 10.36303/sajaa.2020.26.6.s2.2518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is a growing public discussion on the prevalence, diagnosis and treatment of burnout syndrome. The unclear definition and diagnostics of the burnout syndrome are scientifically criticised. Therefore, this narrative review covers various dynamics on burnout and provides insights into the objective usage of burnout.
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Wise RD, de Vasconcellos K, Gopalan D, Ahmed N, Alli A, Joubert I, Kabambi KF, Mathiva LR, Mdladla N, Mer M, Miller M, Mrara B, Omar S, Paruk F, Richards GA, Skinner D, von Rahden R. Critical Care Society of Southern Africa adult patient blood management guidelines: 2019 Round-table meeting, CCSSA Congress, Durban, 2018. South Afr J Crit Care 2020; 36:10.7196/SAJCC.2020.v36i1b.440. [PMID: 37415775 PMCID: PMC10321416 DOI: 10.7196/sajcc.2020.v36i1b.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 07/08/2023] Open
Abstract
The CCSSA PBM Guidelines have been developed to improve patient blood management in critically ill patients in southern Africa. These consensus recommendations are based on a rigorous process by experts in the field of critical care who are also practicing in South Africa (SA). The process comprised a Delphi process, a round-table meeting (at the CCSSA National Congress, Durban, 2018), and a review of the best available evidence and international guidelines. The guidelines focus on the broader principles of patient blood management and incorporate transfusion medicine (transfusion guidelines), management of anaemia, optimisation of coagulopathy, and administrative and ethical considerations. There are a mix of low-middle and high-income healthcare structures within southern Africa. Blood products are, however, provided by the same not-for-profit non-governmental organisations to both private and public sectors. There are several challenges related to patient blood management in SA due most notably to a high incidence of anaemia, a frequent shortage of blood products, a small donor population, and a healthcare system under financial strain. The rational and equitable use of blood products is important to ensure best care for as many critically ill patients as possible. The summary of the recommendations provides key practice points for the day-to-day management of critically ill patients. A more detailed description of the evidence used to make these recommendations follows in the full clinical guidelines section.
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Affiliation(s)
- R D Wise
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - K de Vasconcellos
- Department of Critical Care, King Edward VIII Hospital, Durban; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - D Gopalan
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - N Ahmed
- Surgical ICU, Tygerberg Academic Hospital; Department of Surgical Sciences and Department of Anaesthesiology and Critical Care, Stellenbosch University, Cape Town, South Africa
| | - A Alli
- Department of Anaesthesia, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - I Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - K F Kabambi
- Department of Anaesthesia and Critical Care, Nelson Mandela Academic Hospital, Mthatha; Department of Surgery, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - L R Mathiva
- Intensive Care Unit, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - N Mdladla
- Dr George Mukhari Academic Hospital; Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - M Mer
- Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M Miller
- Department of Anaesthesia and Peri-operative Medicine, Division of Critical Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - B Mrara
- Anaesthesia Department, Walter Sisulu University, Mthatha, South Africa
| | - S Omar
- Department of Critical Care, Chris Hani Baragwanath Academic Hospital and School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - F Paruk
- Department of Critical Care, Steve Biko Academic Hospital and Critical Care, School of Medicine, University of Pretoria, South Africa
| | - G A Richards
- Department of Critical Care, Charlotte Maxeke Johannesburg Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - D Skinner
- Department of Critical Care, King Edward VIII Hospital, Durban; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - R von Rahden
- Private practice (Critical Care), Rodseth and Partners, Pietermaritzburg, South Africa
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6
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Taylor EH, Hofmeyr R, Torborg A, van Tonder C, Boden R, Earle E, Nejthardt M, Kabambi KF, Isaacs M, Usenbo A, Gerber C, van der Spuy K, Mrara B, Ndhlovu T, Chen A, Swanevelder J, Coetzee J, Biccard BM. Risk factors and interventions associated with mortality or survival in adult COVID-19 patients admitted to critical care: a systematic review and meta-analysis. South Afr J Anaesth Analg 2020. [DOI: 10.36303/sajaa.2020.26.3.2428] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Patients with confirmed COVID-19 admitted to intensive care units have a high mortality rate, which appears to be associated with increasing age, male sex, smoking history, hypertension and diabetes mellitus.
Methods: A systematic review to determine risk factors and interventions associated with mortality/survival in adult patients admitted to an intensive care unit (ICU) with confirmed COVID-19/SARS-CoV-2 infection. The protocol was registered with PROSPERO (CRD42020181185).
Results: The search identified 483 abstracts between 1 January and 7 April 2020, of which nine studies were included in the final review. Only one study was of low bias. Advanced age (odds ratio [OR] 11.99, 95% confidence interval [CI] 5.35–18.62) and a history of hypertension were associated with mortality (OR 4.17, 95% CI 2.90–5.99). Sex was not associated with mortality. There was insufficient data to assess the association between other comorbidities, laboratory results or critical care risk indices and mortality. The critical care interventions of mechanical ventilation (OR 6.25, 95% CI 0.75–51.93), prone positioning during ventilation (OR 2.06, 95% CI 0.20–21.72), and extracorporeal membrane oxygenation (ECMO) (OR 8.00, 95% CI 0.69, 92.33) were not associated with mortality. The sample size was insufficient to conclusively determine the association between these interventions and ICU mortality. The need for inotropes or vasopressors was associated with mortality (OR 6.36, 95% CI 1.89–21.36).
Conclusion: The studies provided little granular data to inform risk stratification or prognostication of patients requiring intensive care admission. Larger collaborative research is needed to address this limitation.
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Affiliation(s)
| | | | | | | | | | - E Earle
- University of the Free State
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7
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Torborg A, Cronje L, Thomas J, Meyer H, Bhettay A, Diedericks J, Cilliers C, Kluyts H, Mrara B, Kalipa M, Rodseth R, Biccard B. South African Paediatric Surgical Outcomes Study: a 14-day prospective, observational cohort study of paediatric surgical patients. Br J Anaesth 2018; 122:224-232. [PMID: 30686308 DOI: 10.1016/j.bja.2018.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/29/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs). METHODS We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications. RESULTS We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4-11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2-8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6-1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery. CONCLUSIONS The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs. CLINICAL TRIAL REGISTRATION NCT03367832.
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Affiliation(s)
- A Torborg
- Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa.
| | - L Cronje
- Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa
| | - J Thomas
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, South Africa; Division of Paediatric Anaesthesia, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - H Meyer
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, South Africa; Division of Paediatric Anaesthesia, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - A Bhettay
- Department of Anaesthesia and Pain Medicine, Nelson Mandela Children's Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - J Diedericks
- Department of Anaesthesiology, University of the Free State, Bloemfontein, South Africa
| | - C Cilliers
- Department of Anaesthesiology and Critical Care, Stellenbosch University, Cape Town, South Africa
| | - H Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - B Mrara
- Department of Anaesthesia, Walter Sisulu University, Eastern Cape, South Africa
| | - M Kalipa
- Department of Anaesthesiology, University of Pretoria, Gauteng, South Africa
| | - R Rodseth
- Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa
| | - B Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, South Africa
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Kluyts HL, le Manach Y, Munlemvo DM, Madzimbamuto F, Basenero A, Coulibaly Y, Rakotoarison S, Gobin V, Samateh AL, Chaibou MS, Omigbodun AO, Amanor-Boadu SD, Tumukunde J, Madiba TE, Pearse RM, Biccard BM, Abbas N, Abdelatif AI, Abdoulaye T, Abd-rouf A, Abduljalil A, Abdulrahman A, Abdurazig S, Abokris A, Abozaid W, Abugassa S, Abuhdema F, Abujanah S, Abusamra R, Abushnaf A, Abusnina S, Abuzalout T, Ackermann H, Adamu Y, Addanfour A, Adeleke D, Adigun T, Adisa A, Adjignon SV, Adu-Aryee N, Afolabi B, Agaba A, Agaba P, Aghadi K, Agilla H, Ahmed B, Ahmed EZ, Ahmed AJ, Ahmed M, Ahossi R, Aji S, Akanyun S, Akhideno I, Akhter M, Akinyemi O, Akkari M, Akodjenou J, AL Samateh A, al Shams E, Alagbe-Briggs O, Alakkari E, Alalem R, Alashhab M, Alatise O, Alatresh A, Alayeb Alayeb M, Albakosh B, Albert F, Alberts A, Aldarrat A, Alfari A, Alfetore A, Algbali M, Algddar A, Algedar H, Alghafoud I, Alghazali A, Alhajj M, Alhendery Alhendery A, Alhoty F, Ali A, Ali Y, Ali A, Alioune BS, Alkassem M, Alkchr M, Alkesa T, Alkilani A, Alkobty Alkobty F, Allaye T, Alleesaib S, Alli A, Allopi K, Allorto N, Almajbery A, Almesmary R, Almisslati S, Almoraid F, Alobeidi H, Swaleh A, Swayeb E, Szpytko A, Taiwo N, Tarhuni A, Tarloff D, Tchaou B, Tchegnonsi C, Tchoupa M, Teeka M, Alomami M, Thakoor B, Theunissen M, Thomas B, Thomas M, Thotharam A, Tobiko O, Torborg A, Tshisekedi S, Tshisola S, Tshitangano R, Alphonsus CS, Tshivhula F, Tshuma H, Tumukunde J, Tun M, Udo I, Uhuebor D, Umeh K, Usenbo A, Uwiteyimbabazi J, Van der Merwe D, Alqawi O, van der Merwe F, van der Walt J, van Dyk D, Van Dyk J, van Niekerk J, van Wyk S, van Zyl H, Veerasamy B, Venter P, Vermeulen A, Alraheem A, Villarreal R, Visser J, Visser L, Voigt M, von Rahden RP, Wafa A, Wafula A, Wambugu P, Waryoba P, Waweru E, Alsabri S, Weideman M, Wise RD, Wynne E, Yahya A, Yahya A, Yahya R, Yakubu Y, Yanga J, Yangazov Y, Yousef O, Alsayed A, Yousef G, Youssouf C, Yunus A, Yusuf A, Zeiton A, Zentuti H, Zepharine H, Zerihun A, Zhou S, Zidan A, Alsellabi B, Zimogo Zié S, Zinyemba C, Zo A, Zomahoun L, Zoobei N, Zoumenou E, Zubia N, Al-Serksi M, Alshareef M, Altagazi A, Aluvale J, Alwahedi H, Alzahra E, Alzarouk M, Al-Zubaidy K, Amadou M, Amadou M, Amanor-Boadu SD, Amer AA, Amisi B, Amuthenu M, Anabah T, Anani F, Anderson P, Andriamampionona A, Andrianina L, Anele A, Angelin R, Anjar N, Antùnez O, Antwi-Kusi A, Anyanwu L, Aribi A, Arowolo O, Arrey O, Ashebir DZ, Assefa S, Assoum G, Athanse V, Athombo J, Atiku M, Atito-Narh E, Atomabe A, Attia A, Aungraheeta M, Aurélia D, Ayandipo O, Ayebale A, Azzaidey H, Babajee N, Badi H, Badianga E, Baghni R, Bahta M, Bai M, Baitchu Y, Baloyi A, Bamuza K, Bamuza M, Bangure L, Bankole O, Barongo M, Barow M, Basenero A, Bashiya L, Basson C, Bechan S, Belhaj S, Ben Mansour M, Benali D, Benamour A, Berhe A, Bertie J, Bester J, Bester M, Bezuidenhout J, Bhagwan K, Bhagwandass D, Bhat K, Bhuiyan M, Biccard BM, Bigirimana F, Bikuelo C, Bilby B, Bingidimi S, Bischof K, Bishop DG, Bitta C, Bittaye M, Biyase T, Blake C, Blignaut E, Blignaut F, BN Tanjong B, Bogoslovskiy A, Boloko P, Boodhun S, Bori I, Boufas F, Brand M, Brouckaert NT, Bruwer J, Buccimazza I, Bula Bula I, Bulamba F, Businge B, Bwambale Y, Cacala S, Cadersa M, Cairns C, Carlos F, Casey M, Castro A, Chabayanzara N, Chaibou M, Chaibva T, Chakafa N, Chalo C, Changfoot C, Chari M, Chelbi L, Chibanda J, Chifamba H, Chikh N, Chikumba E, Chimberengwa P, Chirengwa J, Chitungo F, Chiwanga M, Chokoe M, Chokwe T, Chrirangi B, Christian M, Church B, Cisekedi J, Clegg-Lamptey J, Cloete E, Coltman M, Conradie W, Constance N, Coulibaly Y, Cronje L, Da Silva M, Daddy H, Dahim L, Daliri D, Dambaki M, Dasrath A, Davids J, Davies GL, De Lange J, de Wet J, Dedekind B, Degaulle M, Dehal V, Deka P, Delinikaytis S, Desalu I, Dewanou H, Deye MM, Dhege C, Diale B, Dibwe D, Diedericks B, Dippenaar J, Dippenaar L, Diyoyo M, Djessouho E, Dlamini S, Dodiyi-Manuel A, Dokolwana B, Domoyyeri D, Drummond LW, du Plessis D, du Plessis W, du Preez L, Dube K, Dube N, Dullab K, Duvenhage R, Echem R, Edaigbini S, Egote A, Ehouni A, Ekwen G, Ekwunife N, El Hensheri M, Elfaghi I, Elfagieh M, Elfallah S, Elfiky M, Elgelany S, Elghallal A, Elghandouri M, Elghazal Z, Elghobashy A, Elharati F, Elkhogia AM, Elkhwildi R, Ellis S, Elmadani L, Elmadany H, Elmehdawi H, Elmgadmi A, Eloi H, Elrafifi D, Elsaadi G, Elsaity R, Elshikhy A, Eltaguri M, Elwerfelli A, Elyasir I, Elzoway A, Elzufri A, Enendu E, Enicker B, Enwerem E, Esayas R, Eshtiwi M, Eshwehdi A, Esterhuizen J, Esterhuizen TM, Etuk E, Eurayet O, Eyelade O, Fanjandrainy R, Fanou L, Farina Z, Fawzy M, Feituri A, Fernandes N, Ford L, Forget P, François T, Freeman T, Freeman Y, Gacii V, Gadi B, Gagara M, Gakenia A, Gallou P, Gama G, Gamal M, Gandy Y, Ganesh A, Gangaly D, Garcia M, Gatheru A, Gaya S, Gbéhadé O, Gerbel G, Ghnain A, Gigabhoy R, Giles D, Girmaye G, Gitau S, Githae B, Gitta S, Gobin V, Goga R, Gomati A, Gonzalez M, Gopall J, Gordon CS, Gorelyk O, Gova M, Govender K, Govender P, Govender S, Govindasamy V, Green-Harris J, Greenwood M, Grey-Johnson S, Grobbelaar M, Groenewald M, Grünewald K, Guegni A, Guenane M, Gueye S, Guezo M, Gunguwo T, Gweder M, Gwila M, Habimana L, Hadecon R, Hadia E, Hamadi L, Hammouda M, Hampton M, Hanta R, Hardcastle TC, Hariniaina J, Hariparsad S, Harissou A, Harrichandparsad R, Hasan S, Hashmi H, Hayes M, Hdud A, Hebli S, Heerah H, Hersi S, Hery A, Hewitt-Smith A, Hlako T, Hodges S, Hodgson RE, Hokoma M, Holder H, Holford E, Horugavye E, Houston C, Hove M, Hugo D, Human C, Hurri H, Huwidi O, Ibrahim A, Ibrahim T, Idowu O, Igaga I, Igenge J, Ihezie O, Ikandi K, Ike I, Ikuku J, Ilbarasi M, Ilunga I, Ilunga J, Imbangu N, Imessaoudene Z, Imposo D, Iraya A, Isaacs M, Isiguzo M, Issoufou A, Izquirdo P, Jaber A, Jaganath U, Jallow C, Jamabo S, Jamal Z, Janneh L, Jannetjies M, Jasim I, Jaworska MA, Jay Narain S, Jermi K, Jimoh R, Jithoo S, Johnson M, Joomye S, Judicael R, Judicaël M, Juwid A, Jwambi L, Kabango R, Kabangu J, Kabatoro D, Kabongo A, Kabongo K, Kabongo L, Kabongo M, Kady N, Kafu S, Kaggya M, Kaholongo B, Kairuki P, Kakololo S, Kakudji K, Kalisa A, Kalisa R, Kalufwelu M, Kalume S, Kamanda R, Kangili M, Kanoun H, Kapesa, Kapp P, Karanja J, Karar M, Kariuki K, Kaseke K, Kashuupulwa P, Kasongo K, Kassa S, Kateregga G, Kathrada M, Katompwa P, Katsukunya L, Kavuma K, Khalfallah, Khamajeet A, Khetrish S, Kibandwa, Kibochi W, Kilembe A, Kintu A, Kipng’etich B, Kiprop B, Kissoon V, Kisten TK, Kiwanuka J, Kluyts HL, Knox M, Koledale A, Koller V, Kolotsi M, Kongolo M, Konwuoh N, Koperski W, Koraz M, Kornilov A, Koto MZ, Kransingh S, Krick D, Kruger S, Kruse C, Kuhn W, Kuhn W, Kukembila A, Kule K, Kumar M, Kusel BS, Kusweje V, Kuteesa K, Kutor Y, Labib M, Laksari M, Lanos F, Lawal T, Le Manach Y, Lee C, Lekoloane R, Lelo S, Lerutla B, Lerutla M, Levin A, Likongo T, Limbajee M, Linyama D, Lionnet C, Liwani M, Loots E, Lopez AG, Lubamba C, Lumbala K, Lumbamba A, Lumona J, Lushima R, Luthuli L, Luweesi H, Lyimo T, Maakamedi H, Mabaso B, Mabina M, Maboya M, Macharia I, Macheka A, Machowski A, Madiba TE, Madsen A, Madzimbamuto F, Madzivhe L, Mafafo S, Maghrabi M, Mahamane DD, Maharaj A, Maharaj A, Maharaj A, Mahmud M, Mahoko M, Mahomedy N, Mahomva O, Mahureva T, Maila R, Maimane D, Maimbo M, Maina S, Maiwald DA, Maiyalagan M, Majola N, Makgofa N, Makhanya V, Makhaye W, Makhlouf N, Makhoba S, Makopa E, Makori O, Makupe AM, Makwela M, Malefo M, Malongwe S, Maluleke D, Maluleke M, Mamadou KT, Mamaleka M, Mampangula Y, Mamy R, Mananjara M, Mandarry M, Mangoo D, Manirimbere C, Manneh A, Mansour A, Mansour I, Manvinder M, Manyere D, Manzini V, Manzombi J, Mapanda P, Marais L, Maranga O, Maritz J, Mariwa F, Masela R, Mashamba M, Mashava DM, Mashile M, Mashoko E, Masia O, Masipa J, Masiyambiri A, Matenchi M, Mathangani W, Mathe R, Matola CY, Matondo P, Matos-Puig R, Matoug F, Matubatuba J, Mavesere H, Mavhungu R, Maweni S, Mawire C, Mawisa T, Mayeza S, Mbadi R, Mbayabu M, Mbewe N, Mbombo W, Mbuyi T, Mbuyi W, Mbuyisa M, Mbwele B, Mehyaoui R, Menkiti I, Mesarieki L, Metali A, Mewanou S, Mgonja L, Mgoqo N, Mhatu S, Mhlari T, Miima S, Milod I, Minani P, Mitema F, Mlotshwa A, Mmasi J, Mniki T, Mofikoya B, Mogale J, Mohamed A, Mohamed A, Mohamed A, Mohamed S, Mohamed S, Mohamed T, Mohamed A, Mohamed A, Mohamed A, Mohamed P, Mohammed I, Mohammed F, Mohammed M, Mohammed N, Mohlala M, Mokretar R, Molokoane F, Mongwe K, Montenegro L, Montwedi O, Moodie Q, Moopanar M, Morapedi M, Morulana T, Moses V, Mossy P, Mostafa H, Motilall S, Motloutsi S, Moussa K, Moutari M, Moyo O, Mphephu P, Mrara B, Msadabwe C, Mtongwe V, Mubeya F, Muchiri K, Mugambi J, Muguti G, Muhammad A, Mukama I, Mukenga M, Mukinda F, Mukuna P, Mungherera A, Munlemvo DM, Munyaradzi T, Munyika A, Muriithi J, Muroonga M, Murray R, Mushangwe V, Mushaninga M, Musiba V, Musowoya J, Mutahi S, Mutasiigwa M, Mutizira G, Muturi A, Muzenda T, Mvwala K, Mvwama N, Mwale A, Mwaluka C, Mwamba J, Mwanga H, Mwangi C, Mwansa S, Mwenda V, Mwepu I, Mwiti T, Mzezewa S, Nabela L, Nabukenya M, Nabulindo S, Naicker K, Naidoo D, Naidoo L, Naidoo L, Naidoo N, Naidoo R, Naidoo R, Naidoo S, Naidoo T, Naidu T, Najat N, Najm Y, Nakandungile F, Nakangombe P, Namata C, Namegabe E, Nansook A, Nansubuga N, Nantulu C, Nascimento R, Naude G, Nchimunya H, Ndaie M, Ndarukwa P, Ndasi H, Ndayisaba G, Ndegwa D, Ndikumana R, Ndonga AK, Ndung’u C, Neil M, Nel M, Neluheni E, Nesengani D, Nesengani N, Netshimboni L, Ngalala A, Ngari B, Ngari N, Ngatia E, Ngcobo G, Ngcobo T, Ngorora D, Ngouane D, Ngugi K, Ngumi ZW, Nibe Z, Ninise E, Niyondiko J, Njenga P, Njenga M, Njoroge M, Njoroge S, Njuguna W, Njuki P, Nkesha T, Nkuebe T, Nkuliyingoma N, Nkunjana M, Nkwabi E, Nkwine R, Nnaji C, Notoane I, Nsalamba S, Ntlhe L, Ntoto C, Ntueba B, Nyassi M, Nyatela-Akinrinmade Z, Nyawanda H, Nyokabi N, Nziene V, Obadiah S, Ochieng O, Odia P, Oduor O, Ogboli-Nwasor E, Ogendo S, Ogunbode O, Ogundiran T, Ogutu O, Ojewola R, Ojujo M, Ojuka D, Okelo O, Okiya S, Okonu N, Olang P, Omigbodun AO, Omoding S, Omoshoro-Jones J, Onyango R, Onyegbule A, Orjiako O, Osazuwa M, Oscar K, Osinaike B, Osinowo A, Othin O, Otman F, Otokwala J, Ouanes F, Oumar O, Ousseini A, Padayachee S, Pahlana S, Pansegrouw J, Paruk F, Patel M, Patel U, Patience A, Pearse RM, Pembe J, Pengemale G, Perez N, Aguilera Perez M, Peter AM, Phaff M, Pheeha R, Pienaar B, Pillay V, Pilusa K, Pochana M, Polishchuk O, Porrill OS, Post E, Prosper A, Pupyshev M, Rabemazava A, Rabiou M, Rademan L, Rademeyer M, Raherison R, Rajah F, Rajcoomar M, Rakhda Z, Rakotoarijaona A, Rakotoarisoa A, Rakotoarison SR, Rakotoarison R, Ramadan L, Ramananasoa M, Rambau M, Ramchurn T, Ramilson H, Ramjee RJ, Ramnarain H, Ramos R, Rampai T, Ramphal S, Ramsamy T, Ramuntshi R, Randolph R, Randriambololona D, Ras W, Rasolondraibe R, Rasolonjatovo J, Rautenbach R, Ray S, Rayne SR, Razanakoto F, Reddy S, Reed AR, Rian J, Rija F, Rink B, Robelie A, Roberts C, Rocher A, Rocher S, Rodseth RN, Rois I, Rois W, Rokhsi S, Roos J, Rorke NF, Roura H, Rousseau F, Rousseau N, Royas L, Roytowski D, Rungan D, Rwehumbiza S, Ryabchiy B, Ryndine V, Saaiman C, Sabwa H, Sadat S, Saed S, Salaheddin E, Salaou H, Saleh M, Salisu-Kabara H, Doles Sama H, Samateh AL, Sam-Awortwi W, Samuel N, Sanduku D, Sani CM, Sanyang L, Sarah H, Sarkin-Pawa A, Sathiram R, Saurombe T, Schutte H, Sebei M, Sedekounou M, Segooa M, Semenya E, Semo B, Sendagire C, Senoga S, Senusi F, Serdyn T, Seshibe M, Shah G, Shamamba R, Shambare C, Shangase T, Shanin S, Shefren I, Sheshe A, Shittu O, Shkirban A, Sholadoye T, Shubba A, Sigcu N, Sihope S, Sikazwe D, Sikombe B, Simaga Abdoul K, Simo W, Singata K, Singh A, Singh S, Singh U, Sinoamadi V, Sipuka N, Sithole N, Sitima S, Skinner DL, Skinner G, Smith O, Smits C, Sofia M, Sogoba G, Sohoub A, Sookun S, Sosinska O, Souhe R, Souley G, Souleymane T, Spicer J, Spijkerman S, Steinhaus H, Steyn A, Steyn G, Steyn H, Stoltenkamp HL, Stroyer S. The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications. Br J Anaesth 2018; 121:1357-1363. [PMID: 30442264 DOI: 10.1016/j.bja.2018.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/19/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. METHODS ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. RESULTS The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. CONCLUSIONS This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. CLINICAL TRIAL REGISTRATION NCT03044899.
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Affiliation(s)
- H-L Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa
| | - Y le Manach
- Department of Anesthesia, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, ON, Canada
| | - D M Munlemvo
- University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - F Madzimbamuto
- Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - A Basenero
- Ministry of Health and Social Services Namibia, Windhoek, Namibia
| | - Y Coulibaly
- Department, Faculté de médicine de Bamako, Bamako, Mali
| | | | - V Gobin
- Ministry of Health and Quality of Life, Jawaharlal Nehru Hospital, Rose Belle, Grand Port, Mauritius
| | - A L Samateh
- Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia
| | - M S Chaibou
- Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Niamey, Niger
| | - A O Omigbodun
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - S D Amanor-Boadu
- Department of Anaesthesia, University College Hospital, Ibadan, Oyo State, Nigeria
| | - J Tumukunde
- Makerere University, Makerere, Kampala, Uganda
| | - T E Madiba
- Department of Surgery, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - R M Pearse
- Intensive Care Medicine, Queen Mary University of London, London, UK
| | - B M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Western Cape, South Africa.
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Mrara B, Roberts J, Gowardman J. Digoxin prescription in the critically ill: an unpredictably loaded problem? Anaesth Intensive Care 2013; 41:434-436. [PMID: 23659414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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