Epidemiological profile and factors influencing the short term postoperative outcomes of thoracic surgical conditions treated at tertiary hospitals in Rwanda

Abstract

Background: Thoracic surgical conditions are widely considered to be among the most important entities requiring specialized care that tends to be more readily available in developed countries than low to middle income countries (LMICs). There is shortage of surgical workforce, high-quality trainings and infrastructure required for thoracic procedures in Rwanda. Furthermore, there is a lack of epidemiological data to estimate the burden of the diseases and few available studies in Rwanda appear to be not well grounded and failed to identify the factors influencing the outcomes. This study describes the epidemiological profile of patients undergoing thoracic procedures and factors associated with outcomes in tertiary hospitals in Rwanda. Methods: This was a cross sectional observational study composed with two data groups collected retrospectively and prospectively in 3 tertiary hospitals in Rwanda: CHUK, CHUB and KFH, K. We documented patients demographics, operative details and 30 days post-operative outcomes. Data were collected using a pre-established questionnaire, electronically captured and analyzed using Stata version 13. Descriptive statistics were used to generate frequencies and percentages of categorical variables. Bivariate and multivariate analysis was done to assess correlations between variables and factors associated with morbidity and mortality. Results: In total, 142 patients were included. The mean age was 42.2 years with male predominance. Empyema thoracis, lung tumors and mediastinal tumors were the most common pathologies in 42.9%, 26% and 11.9% respectively. Lung decortication, lobectomy, thoracic mass biopsy are the most performed procedures in 42.5%, 14.8% and 14.1% respectively. The morbidity was 58.45% and the main complications were pneumonia in 48%, surgical site infection in 29% and organ failure in 20% of the patients and the mortality was 11.97%. The overall median LOS was 8.5 (3-57) days .The logistic regression analysis showed that the factors with a significant association with postoperative complications were ASA score ≥ III (OR: 6.82; 95% CI, 1.01-49.7), duration of operation ≥3hours (OR: 58.81, 95% CI 7.08-488.2), general surgeon (OR: 9.24; 95% CI, 1.95-43.70) and open surgery (OR: 12.36; 95% CI, 1.3-111.2). Conclusion: In Rwanda, there is a high incidence of postoperative complications following thoracic procedures. Factors associated with complications are ASA class ≥ III, duration of operation ≥3hours, general surgeon and open surgery. Therefore, we recommend to routinely using the “ASA classification” as a preoperative risk stratification tool, improving thoracic surgery skills for general surgeons and/or starting a thoracic surgery fellowship in Rwanda for improved outcomes and sustainable progress in thoracic surgical care