Factors Associated with Postoperative Complications Among Elderly Patients Undergoing Abdominal Surgery in Rwanda

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.