Abstract:
Introduction
The proportion of older adults is rising in Rwanda, and patients in this age group are increasingly undergoing surgical interventions. However, there is a huge knowledge gap in factors affecting surgical outcomes of geriatric patients in low-income countries. This study aimed to identify factors associated with major postoperative complications (Clavien-Dindo grade ≥ III) among patients ≥ 60 years who undergo abdominal surgery in Rwanda.
Methods
We conducted a multi-centric, analytic cross-sectional study over seven months from August 2020 to February 2021 at five hospitals across Rwanda. Patients ≥ 60 years undergoing abdominal surgery were included in the study. The primary outcome was 30 -day postoperative complications as defined by the Clavien-Dindo classification.
Results
In total, 160 patients were included. The mean age was 69.4 years. 56.9% were male, and 43.1% were female. The prevalence of comorbidities was 36.9%. The leading indications of abdominal surgery were benign intestinal obstruction (29.4%) and gastric cancer (19 .4%). Major postoperative complications occurred in 33 .1% of patients. The overall 30-day mortality was 24.4%. After univariate and multivariate analyses, factors with a signif icant association with major postoperative complications were frailty (odds ratio [OR], 2.541; 95% confidence interval [CI], 1.069-6.035; P-value, 0.035), American Society of Anesthesiologists (ASA) class ≥ III (OR, 5.303; 95% CI, 2.402-11.707; P-value, <0 .001 ) and emergency surgery (OR, 2.659; 95% CI, 1.153-6.130; P-value, 0.022).
Conclusion
In Rwanda, there is a high incidence of postoperative complications following abdominal surgery in elderly patients. Factors associated with major complications are frailty, ASA class ≥ III, and emergency surgery. Therefore, we recommend using the “ASA classification” as a preoperative risk stratification tool and routine screening f or f railty to identify high-risk patients who can benefit from best practices that minimize postoperative complications.
