9 research outputs found
The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications
No full textBackground:
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.
© 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran
Postoperative Outcomes Associated With Procedural Sedation Conducted by Physician and Nonphysician Anesthesia Providers: Findings From the Prospective, Observational African Surgical Outcomes Study
No full textMaternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study : a 7-day prospective observational cohort study
No full textCITATION: Bishop, D. et al. Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study : a 7-day prospective observational cohort study. The Lancet Global Health, 7(2):e513-e522. doi:10.1016/S2214-109X(19)30036-1The original publication is available at https://www.thelancet.com/journals/langlo/issue/vol7no2/PIIS2214-109X(19)X0002-9Background: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes.
Methods: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery
in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years)
admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort
period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the
recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed
by local investigators. The study was registered on the South African National Health Research Database, number
KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899.
Findings: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were
included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality
analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and
anaesthetists totalling 0·7 per 100000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients
(95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly
severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently
associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum
haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34])
or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0).
Interpretation: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income
countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the
global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage
might improve maternal and neonatal outcomes in Africa.https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30036-1/fulltextPublisher’s versio
Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study
No full textFunding
Medical Research Council of South Africa
Method of Anesthesia and Perioperative Risk Factors, Maternal Anesthesia Complications, and Neonatal Mortality Following Cesarean Delivery in Africa: A Substudy of a 7-Day Prospective Observational Cohort Study.
No full textBACKGROUND: The African Surgical Outcomes Study (ASOS) found that maternal mortality following cesarean delivery in Africa is 50 times higher than in high-income countries, and associated with obstetric hemorrhage and anesthesia complications. Mothers who died were more likely to receive general anesthesia (GA). The associations between GA versus spinal anesthesia (SA) and preoperative risk factors, maternal anesthesia complications, and neonatal outcomes following cesarean delivery in Africa are unknown. METHODS: This is a secondary explanatory analysis of 3792 patients undergoing cesarean delivery in ASOS, a prospective observational cohort study, across 22 African countries. The primary aim was to estimate the association between preoperative risk factors and the outcome of the method of anesthesia delivered. Secondary aims were to estimate the association between the method of anesthesia and the outcomes (1) maternal intraoperative hypotension, (2) severe maternal anesthesia complications, and (3) neonatal mortality. Generalized linear mixed models adjusting for obstetric gravidity and gestation, American Society of Anesthesiologists (ASA) category, urgency of surgery, maternal comorbidities, fetal distress, and level of anesthesia provider were used. RESULTS: Of 3709 patients, SA was performed in 2968 (80%) and GA in 741 (20%). Preoperative factors independently associated with GA for cesarean delivery were gestational age (adjusted odds ratio [aOR], 1.093; 95% confidence interval [CI], 1.052-1.135), ASA categories III (aOR, 11.84; 95% CI, 2.93-46.31) and IV (aOR, 11.48; 95% CI, 2.93-44.93), eclampsia (aOR, 3.92; 95% CI, 2.18-7.06), placental abruption (aOR, 6.23; 95% CI, 3.36-11.54), and ruptured uterus (aOR, 3.61; 95% CI, 1.36-9.63). SA was administered to 48 of 94 (51.1%) patients with eclampsia, 12 of 28 (42.9%) with cardiac disease, 14 of 19 (73.7%) with preoperative sepsis, 48 of 76 (63.2%) with antepartum hemorrhage, 30 of 55 (54.5%) with placenta previa, 33 of 78 (42.3%) with placental abruption, and 12 of 29 (41.4%) with a ruptured uterus. The composite maternal outcome "all anesthesia complications" was more frequent in GA than SA (9/741 [1.2%] vs 3/2968 [0.1%], P < .001). The unadjusted neonatal mortality was higher with GA than SA (65/662 [9.8%] vs 73/2669 [2.7%], P < .001). The adjusted analyses demonstrated no association between method of anesthesia and (1) intraoperative maternal hypotension and (2) neonatal mortality. CONCLUSIONS: Analysis of patients undergoing anesthesia for cesarean delivery in Africa indicated patients more likely to receive GA. Anesthesia complications and neonatal mortality were more frequent following GA. SA was often administered to high-risk patients, including those with eclampsia or obstetric hemorrhage. Training in the principles of selection of method of anesthesia, and the skills of safe GA and neonatal resuscitation, is recommended
Mortalidad global postoperatoria a 30 días en pacientes del régimen contributivo en Colombia, 2015
No full textBackground and Goal of Study: All countries must report perioperative mortality in order to improve the quality of care and health services allowing a safe access to surgery and anesthesia. Denominator must be total number of surgical procedures. Colombia is lacking of all this information, thus we are focusing this study to determine 30-day postoperative mortality associated with major surgical procedures in patients within contributory health system in Colombia, during 2015.
Methods and design: Retrospective cohort study based on administrative database of patients within contributory health system in 2015. 30-day mortality was estimated adjusting risk for patient sex, surgical specialty, and Charlson comorbidities index.
Results: 25 surgical groups underwent statistical analysis. Here we exposed the results of one of them: cardiac surgery. 5208 procedures were performed. Intrahospital mortality was 4,32% OR 1,16 (0,87-1,54) and 30-day postoperative mortality was 5,78% OR 1,08 (0,86-1,39). There was not statistically significant difference found, based on the sex of the patient.
Conclusions: In Colombia we must prioritize to describe 30-day postoperative mortality in order to create a strategy for safe access to surgery and anesthesia. Also, it allows us to outline a plan that can improve the statistics at the regional and national levels.Contexto y objetivo: Con el fin de mejorar la calidad de la atención brindada garantizando un acceso seguro a la cirugía y a la anestesia es necesario el reporte por parte de todos los países de la mortalidad perioperatoria, en forma de porcentaje y usando en la ecuación el número total de cirugías como denominador. En Colombia carecemos de esta información de la forma como es presentada en los países desarrollados por lo que se busca determinar la mortalidad postoperatoria a 30 días asociada a los procedimientos quirúrgicos mayores en pacientes del régimen contributivo en Colombia durante el año 2015.
Métodos y diseño: Se recolectó información de una base de datos administrativa de los pacientes pertenecientes al régimen contributivo durante el año 2015, mediante un estudio de cohorte retrospectivo determinando la mortalidad postoperatoria a 30 días. Se realizó un ajuste del riesgo por sexo del paciente, de acuerdo a las especialidades quirúrgicas y con las patologías asociadas usando el índice de comorbilidades de Charlson.
Resultados: Se sometieron a análisis estadístico 25 grupos quirúrgicos. Se muestran los resultados de un grupo quirúrgico: cirugía cardíaca. 5208 procedimientos de cirugía cardíaca fueron realizados, encontrando que la mortalidad postoperatoria intrahospitalaria fue del 4,32% OR 1,16 (0,87-1,54) y a 30 días del 5,78% OR 1,08 (0,86-1,39). No se encontró una diferencia estadísticamente significativa con relación a la mortalidad intrahospitalaria o a 30 días basado en el sexo del paciente.
Conclusiones: Describir la mortalidad postoperatoria a 30 días en Colombia debe ser una prioridad como estrategia de acceso a la cirugía y a la anestesia segura. Esto permite esbozar conductas que puedan mejorar las cifras a nivel regional y nacional.Especialidades Médica
Development and characterization of oleogels from avocado oil (Persea americana 'Lorena') structured with monoglycerides.
No full textEl objetivo de este estudio fue desarrollar oleogeles a partir de aceite de aguacate (*Persea americana* ‘Lorena’), utilizando un monoglicérido comercial como agente estructurante. El aceite se obtuvo mediante dos métodos de extracción mecánica sin el uso de solventes, garantizando su idoneidad para el consumo humano y su cumplimiento con normas de calidad nacionales e internacionales. Los métodos de extrusión mecánica y compresión hidráulica permitieron obtener aceites con características fisicoquímicas apropiadas. Para la formación de oleogeles, se empleó un diseño experimental de superficie de respuesta con el método de Box-Behnken, evaluando el efecto de la concentración de monoglicéridos, temperatura y tiempo de calentamiento sobre la capacidad de retención de aceite (CRA), firmeza y color del gel. Los resultados indicaron que tanto la concentración del monoglicérido como la temperatura influyeron significativamente en la CRA y firmeza, mientras que el color se vio afectado solo por la concentración. Se optimizó el proceso para maximizar la CRA y alcanzar una firmeza adecuada, obteniendo condiciones óptimas de 7,98 % de monoglicérido, 86 °C de temperatura y 17 minutos de calentamiento. Estas condiciones generaron un oleogel con una CRA del 85,95 %, que posiblemente se vio afectada por una distribución no uniforme del agente estructurante y variaciones en la temperatura de enfriamiento del gel (temperatura ambiente). El análisis reológico mostró que el oleogel obtenido exhibía un comportamiento viscoelástico, con un módulo de almacenamiento (G') superior al módulo de pérdida (G'') en las frecuencias evaluadas, lo que sugiere su capacidad de almacenar energía. Sin embargo, el límite de la región viscoelástica lineal (LVR) fue bajo, indicando una estructura relativamente débil, lo que podría limitar su aplicabilidad en matrices que requieren mayor estabilidad mecánica. Además, la estabilidad oxidativa del oleogel fue superior a la del aceite puro, con 47,71 h frente a 10,80 h en el análisis Rancimat. (Texto tomado de la fuente)The objective of this study was to develop oleogels from avocado oil (*Persea americana* 'Lorena'), using a commercial monoglyceride as a structuring agent. The oil was obtained through two solvent-free mechanical extraction methods, ensuring its suitability for human consumption and compliance with national and international quality standards. The mechanical extrusion and hydraulic pressing methods resulted in oils with appropriate physicochemical characteristics. For oleogel formation, a response surface methodology was applied using the Box-Behnken design to evaluate the effect of monoglyceride concentration, temperature, and heating time on oil retention capacity (CRA), firmness, and gel color. The results indicated that both the concentration of monoglycerides and temperature significantly influenced CRA and firmness, while color was affected only by concentration. The process was optimized to maximize CRA and achieve adequate firmness, obtaining optimal conditions of 7,98 % monoglyceride, 86°C temperature, and 17 minutes of heating. These conditions yielded an oleogel with a CRA of 85,95 %, which may have been affected by uneven distribution of the structuring agent and variations in cooling conditions (ambient temperature). Rheological analysis showed that the obtained oleogel exhibited viscoelastic behavior, with a storage modulus (G') higher than the loss modulus (G'') at the evaluated frequencies, indicating its ability to store energy. However, the linear viscoelastic region (LVR) limit was low, suggesting a relatively weak structure, which could limit its application in matrices requiring greater mechanical stability. Additionally, the oxidative stability of the oleogel was superior to that of pure oil, with 47,71 hours compared to 10,80 hours in the Rancimat analysis.“Red de cooperación Biorrefinerías desde la docencia, la extensión y la investigación (BioR-DEI)” de la Universidad Nacional de Colombia – (código Hermes 57909) por su invaluable respaldo y colaboración en el desarrollo del proyecto.Proyecto de regalías ‘‘Desarrollo, validación e implementación de tecnologías innovadoras para el manejo integral y la gestión de sistemas de cultivo de aguacate en los municipios de Monterrey, Sabanalarga y Tauramena del departamento de Casanare’’, ejecutado por la Facultad de Ciencias Agrarias de la Universidad Nacional de Colombia sede – BogotáMaestríaMagíster en Ciencia y Tecnología de AlimentosDiseño y desarrollo de productosCiencias Agronómicas.Sede Bogot
Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study
No full textSummary: Background: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34]) or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0). Interpretation: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. Funding: Medical Research Council of South Africa
