Postoperative outcomes associated with surgical care for women in Africa: an international risk-adjusted analysis

Background There is an increasing call for a broader approach to women's surgical care in low- and middle-income countries, beyond access to caesarean section. While obstetric outcomes in Africa are well described, outcomes following non-obstetric surgical care for women in Africa are relatively unknown. Methods We did a secondary analysis of the African Surgical Outcomes Study (ASOS) focusing on severe postoperative complications (defined as death and severe complications) in females following non-obstetric, non-gynaecological surgical procedures. ASOS was a seven-day, African multi-centre prospective observational cohort study of adult (≥18 years) patients undergoing surgery in 25 African countries. These African outcomes were compared to international outcomes from the International Surgical Outcomes Study (ISOS) in a riskadjusted logistic regression analysis. Findings There were 1498 African participants and 18449 international participants who met the inclusion criteria. The African cohort were younger than the international cohort (47 (17) years versus 57 (17); p= <0·0001) and had a lower preoperative risk profile. Severe complications occurred in 41 (2·8%) of 1471 patients of the African cohort, and 431 (2·3%) of 18449 patients in the ISOS cohort, with in-hospital mortality following severe complications of 20/41 (48·8%) in ASOS and 78/431 (18·1%) in ISOS. The adjusted odds ratio for a woman in Africa developing a severe postoperative complication following elective non-obstetric, non-gynaecological surgery compared to the international incidence was 2·114 (95% CI 1·468 - 3·042, p