A multivariable model of the association between postoperative complications and 30-day in-hospital mortality in the African surgical outcome study (ASOS) cohort
| dc.contributor.advisor | Biccard, Bruce | |
| dc.contributor.advisor | Myer, Benjamin | |
| dc.contributor.author | Simons, Caroline | |
| dc.date.accessioned | 2026-07-24T09:28:24Z | |
| dc.date.available | 2026-07-24T09:28:24Z | |
| dc.date.issued | 2026 | |
| dc.date.updated | 2026-07-24T09:27:29Z | |
| dc.description.abstract | BACKGROUND: The perioperative mortality rate in Africa is twice the global average. Postoperative complications independently associated with postoperative mortality has not been explored in this region. The aim of this study was to determine which severe postoperative complications are independently associated with postoperative mortality in Africa. METHODS: Data from an African prospective observational study of perioperative adult patients conducted in 2016 was analysed. We used a logistic mixed-effects model to assess the association between severe postoperative complications and 30-day postoperative mortality, adjusting for known patient and surgical factors. This model was used to calculate the attributable fraction (AF) of death. RESULTS: We included 10 748 patients of whom 222 (2.07%) died in hospital within the 30day postoperative period. The severe postoperative complications with the highest adjusted odds ratios (OR) for mortality were pulmonary embolism (OR 349, 95% confidence interval (CI) 61.6 – 1980, p < 0.001), pulmonary oedema (OR 44.8, 95% CI 5.34 – 375, p < 0.001) and bloodstream infections (OR 33.5, 95% CI 15.2 – 73.7, p < 0.001). The severe complications with the highest AF to 30-day postoperative mortality were bloodstream infections (AF 51.33%, 95% CI 40.1 – 60.51), acute kidney injury or AKI (AF 27.64%, 95% CI 17.98 – 36.22), and pneumonia (AF 26.55%, 95% CI 16.98 – 35.01). CONCLUSIONS: The complications with the highest AF for postoperative mortality in Africa identify the complications with the greatest contribution to the postoperative mortality which can guide priorities for future interventional strategies to decrease postoperative mortality in Africa. | |
| dc.identifier.apacitation | Simons, C. (2026). <i>A multivariable model of the association between postoperative complications and 30-day in-hospital mortality in the African surgical outcome study (ASOS) cohort</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/43666 | en_ZA |
| dc.identifier.chicagocitation | Simons, Caroline. <i>"A multivariable model of the association between postoperative complications and 30-day in-hospital mortality in the African surgical outcome study (ASOS) cohort."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2026. http://hdl.handle.net/11427/43666 | en_ZA |
| dc.identifier.citation | Simons, C. 2026. A multivariable model of the association between postoperative complications and 30-day in-hospital mortality in the African surgical outcome study (ASOS) cohort. . University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. http://hdl.handle.net/11427/43666 | en_ZA |
| dc.identifier.ris | TY - Thesis / Dissertation AU - Simons, Caroline AB - BACKGROUND: The perioperative mortality rate in Africa is twice the global average. Postoperative complications independently associated with postoperative mortality has not been explored in this region. The aim of this study was to determine which severe postoperative complications are independently associated with postoperative mortality in Africa. METHODS: Data from an African prospective observational study of perioperative adult patients conducted in 2016 was analysed. We used a logistic mixed-effects model to assess the association between severe postoperative complications and 30-day postoperative mortality, adjusting for known patient and surgical factors. This model was used to calculate the attributable fraction (AF) of death. RESULTS: We included 10 748 patients of whom 222 (2.07%) died in hospital within the 30day postoperative period. The severe postoperative complications with the highest adjusted odds ratios (OR) for mortality were pulmonary embolism (OR 349, 95% confidence interval (CI) 61.6 – 1980, p < 0.001), pulmonary oedema (OR 44.8, 95% CI 5.34 – 375, p < 0.001) and bloodstream infections (OR 33.5, 95% CI 15.2 – 73.7, p < 0.001). The severe complications with the highest AF to 30-day postoperative mortality were bloodstream infections (AF 51.33%, 95% CI 40.1 – 60.51), acute kidney injury or AKI (AF 27.64%, 95% CI 17.98 – 36.22), and pneumonia (AF 26.55%, 95% CI 16.98 – 35.01). CONCLUSIONS: The complications with the highest AF for postoperative mortality in Africa identify the complications with the greatest contribution to the postoperative mortality which can guide priorities for future interventional strategies to decrease postoperative mortality in Africa. DA - 2026 DB - OpenUCT DP - University of Cape Town KW - attributable fraction of death KW - Africa KW - perioperative outcomes KW - global surgery KW - postoperative mortality KW - postoperative complications LK - https://open.uct.ac.za PB - University of Cape Town PY - 2026 T1 - A multivariable model of the association between postoperative complications and 30-day in-hospital mortality in the African surgical outcome study (ASOS) cohort TI - A multivariable model of the association between postoperative complications and 30-day in-hospital mortality in the African surgical outcome study (ASOS) cohort UR - http://hdl.handle.net/11427/43666 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/43666 | |
| dc.identifier.vancouvercitation | Simons C. A multivariable model of the association between postoperative complications and 30-day in-hospital mortality in the African surgical outcome study (ASOS) cohort. []. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2026 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/43666 | en_ZA |
| dc.language.iso | en | |
| dc.language.rfc3066 | eng | |
| dc.publisher.department | Department of Public Health and Family Medicine | |
| dc.publisher.faculty | Faculty of Health Sciences | |
| dc.publisher.institution | University of Cape Town | |
| dc.subject | attributable fraction of death | |
| dc.subject | Africa | |
| dc.subject | perioperative outcomes | |
| dc.subject | global surgery | |
| dc.subject | postoperative mortality | |
| dc.subject | postoperative complications | |
| dc.title | A multivariable model of the association between postoperative complications and 30-day in-hospital mortality in the African surgical outcome study (ASOS) cohort | |
| dc.type | Thesis / Dissertation | |
| dc.type.qualificationlevel | Masters | |
| dc.type.qualificationlevel | MPH |