AI Insight
This multicenter study examined outcomes of 265 cancer surgeries performed across 46 Ethiopian hospitals over a 7-day period. Despite patients being relatively young with predominantly low-risk health status classifications, 31.7% developed postoperative complications, 11% required reoperation, and 1.9% died within seven days. Emergency surgery, existing comorbidities, and poor functional performance status were significantly associated with increased complication rates.
Why it matters
The findings reveal substantial gaps in surgical care quality for cancer patients in Ethiopia, with complication rates considerably higher than expected given the patient population's favorable baseline characteristics. This highlights urgent needs for infrastructure improvements and standardized care protocols in low-resource settings where cancer burden is growing but surgical safety lags behind high-income countries.
Understand the Science
by Atalel Fentahun Awedew, Yonatan Abie Tsegaye, Addisu Assfaw Ayen, Fisiha Guade Tesifaw, Bedemariam Tadesse Amsalu, Amsalu Molla Getahun
Background
Safe surgery is a fundamental quality indicator within the global surgery framework. Postoperative complications remain a leading global cause of disability, mortality, and economic loss, with a disproportionate impact on low- and middle-income countries (LMICs).
Objective
This study aims to generate robust epidemiological data on postoperative outcomes of cancer surgery in Ethiopia.
Methods
This study employed a 7-day national observational prospective cohort design. The study enrolled adult patients aged 18 years and older who underwent either elective or non-elective cancer surgery in hospitals across Ethiopia. Statistical analysis included descriptive statistics, chi-square tests for categorical variables, and logistic regression models to identify risk factors for postoperative complications. Outcome measures 7th day postoperative mortality and complications. Statistical significance was set at p < 0.05.
Results
A total of 265 cancer surgeries were performed across 46 hospitals (overall surgeries = 4412). The mean patient age was 46.6 years (SD = 14.9). The majority of patients were classified as low-risk America Society of Anesthesiologists (ASA) physical status classification: ASA I (106/265, 40%) and ASA II (133/265, 50.2%) and low Eastern Cooperative Oncology Group (ECOG) performance status: ECOG 0 (112/265, 42.3%) and ECOG 1 (98/265, 37%). Colorectal cancer surgery was the most common type (38/265, 14.5%), while laparoscopic surgery was performed in only 3/265 cases (1.1%). Postoperative complications developed in 84 of 265 patients (31.7%) with leading complication was superficial surgical site infection 47/265(17.8%). Emergency surgery (AOR = 3.1, 95% CI: 1.1–8.4, p = 0.003), comorbidity (AOR = 2.0, 95% CI: 1.1–3.7, p = 0.025), and an ECOG performance status of III (AOR = 9.5, 95% CI: 1.5–61.1, p = 0.02) were statistically significantly associated with 7th day postoperative complications. The overall 7-day mortality rate after cancer surgery was 5/265 (1.9%).
Conclusion
Despite the relatively young age of patients, their low ASA physical status scores, and good ECOG performance, a significant proportion experienced adverse outcomes following cancer surgery: one in three patients developed postoperative complications, one in nine required reoperations, and one in 53 died. These findings suggest a critical need for evidence-based interventions to strengthen the underlying infrastructure and care processes within the surgical system which are essential to achieving safe, effective, and high-quality surgical care for cancer patients in Ethiopia.