title: Perioperative mortality: Analysis of 3 years of operative data across 7 general surgical projects of Médecins Sans Frontières in Democratic Republic of Congo, Central African Republic, and South Sudan.
abstract: BACKGROUND
  The African continent has the greatest burden of surgical disability-adjusted life years, yet the least is known about operative care here. This analysis describes the surgical patients admitted to 7 hospitals supported by the Médécins Sans Frontières (MSF) over 3 years in 3 conflict-affected countries-Eastern Democratic Republic of Congo, Central African Republic, and South Sudan.
  
  
  METHODS
  A standardized operative data collection tool was used for routine collection of operative inpatient data between 2011 and 2013 at 7 MSF surgical facilities. Surgical records of 14,482 patients were analyzed to describe surgical epidemiology, major procedures, and perioperative mortality. The perioperative mortality rate (POMR) was calculated within 2 days of admission (POMR2) and within 30 days from admission (POMR30). The POMR is used as a marker of quality of operative care.
  
  
  RESULTS
  Caesarean delivery was the most common major procedure performed and had a POMR30 of 5.28 per 1,000 admissions. The overall inpatient mortality was 19.67 per 1,000 admissions. Children had greater POMR than adults for the same procedure types (47.97 vs 15.89 deaths per 1,000 admissions, P < .001); 85.1% of all major procedures were emergency procedures and between 3 and 30% of admissions were related to violence. After adjustment, perioperative death was associated with emergency surgery, violence, and age younger than 15 years.
  
  
  CONCLUSIONS
  POMRs varied by age group and type of major procedure performed. Collecting surgical data is achievable and can inform future planning and support for national surgical programs. More information is needed on operative outcomes in adults and children in low-resource settings to improve quality and access to care.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Jessica F
authors.initials: JF
authors.lastname: Davies
authors.affiliation: Médecins Sans Frontières - Operational Centre Amsterdam, Amsterdam, Netherlands. Electronic address: Annick.Lenglet@amsterdam.msf.org.
authors.forename: Annick
authors.initials: A
authors.lastname: Lenglet
authors.affiliation: Médecins Sans Frontières - Operational Centre Amsterdam, Amsterdam, Netherlands.
authors.forename: Marten
authors.initials: M
authors.lastname: van Wijhe
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Cono
authors.initials: C
authors.lastname: Ariti
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002488:Central African Republic / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D013502:General Surgery; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008493:Medical Missions; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D000068037:South Sudan / Q000453:epidemiology; D013514:Surgical Procedures, Operative / Q000401:mortality*; D055815:Young Adult