ABSTRACT
BACKGROUND: Data on the factors that influence mortality after surgery in South Africa are scarce, and neither these data nor data on risk-adjusted in-hospital mortality after surgery are routinely collected. Predictors related to the context or setting of surgical care delivery may also provide insight into variation in practice. Variation must be addressed when planning for improvement of risk-adjusted outcomes. Our objective was to identify the factors predicting in-hospital mortality after surgery in South Africa from available data. METHODS: A multivariable logistic regression model was developed to identify predictors of 30-day in-hospital mortality in surgical patients in South Africa. Data from the South African contribution to the African Surgical Outcomes Study were used and included 3800 cases from 51 hospitals. A forward stepwise regression technique was then employed to select for possible predictors prior to model specification. Model performance was evaluated by assessing calibration and discrimination. The South African Surgical Outcomes Study cohort was used to validate the model. RESULTS: Variables found to predict 30-day in-hospital mortality were age, American Society of Anesthesiologists Physical Status category, urgent or emergent surgery, major surgery, and gastrointestinal-, head and neck-, thoracic- and neurosurgery. The area under the receiver operating curve or c-statistic was 0.859 (95% confidence interval: 0.827-0.892) for the full model. Calibration, as assessed using a calibration plot, was acceptable. Performance was similar in the validation cohort as compared to the derivation cohort. CONCLUSION: The prediction model did not include factors that can explain how the context of care influences post-operative mortality in South Africa. It does, however, provide a basis for reporting risk-adjusted perioperative mortality rate in the future, and identifies the types of surgery to be prioritised in quality improvement projects at a local or national level.
Subject(s)
Delivery of Health Care/standards , Hospital Mortality , Models, Statistical , Surgical Procedures, Operative/mortality , Adult , Clinical Decision Rules , Delivery of Health Care/statistics & numerical data , Female , Healthcare Disparities/statistics & numerical data , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Assessment , Risk Factors , South Africa/epidemiology , Surgical Procedures, Operative/adverse effects , Treatment OutcomeABSTRACT
El uso de opioides administrados por via intratecal como agentes para anestesia espinal cobra particular interes en los ultimos años. Se estudiaron 75 pacientes, estado fisico ASA I-II, intervenidos por cirugia electiva de hemiabdomen inferior, dividos en dos grupos de 37 y 39 pacientes, respectivamente, a los que se les administro meperidina intratecal en dosis de 0,5 mg.Kg mas dextrosa 5 por ciento a completar 3 ml. en el grupo II se adminsitro ademas 0,1 mg de epinefrina 1: 200 000. Se determino y comparo inicio de accion, nivel y duracion del bloqueo sensorial, bloqueo motor en el momento de la incision (segun escala de Bromage), duracion de la analgesia postoperatoria y efectos adversos. (AU)
