Background: Cancellation of scheduled surgery leads to operating theatre under-occupancy and is recognised as a major cause of emotional trauma to patients and their families. This study aimed to assess the incidence of elective surgery cancellation in order to make proposals for healthcare improvement. Methods: A prospective study was undertaken on cancellation of scheduled surgery in the general surgery service. Cancellation is considered to have occurred when planned surgery did not take place on the day it was scheduled and recognised as 'final' when it was no longer considered at a later date. Cancellations were classed as 'avoidable' or 'unavoidable' . Results: A total of 103 surgeries were scheduled for patients with an average age of 41.1 years. Abdominal surgery (36.9%) dominated and 63.1% (n = 65) of the operations were scheduled. Some 36.9% (n = 38) of interventions were delayed, of which 9.7% (n = 10) were definitively cancelled and 27.2% (n = 28) were carried forward. Half of the cancellations (47.4%) were related to equipment and 31.6% related to patient factors. Hospital-related cancellation accounted for 63.9%. Cancellation was avoidable in 68.5% of cases. A financial cause was relevant for 16.6% (n = 6) and 2.6% of cancellations were due to a 'long preceding intervention' . Conclusion: The impact of cancellation is high and better organisation and communication between relevant role players within the operating theatre should reduce unnecessary cancellation.

BackgroundIn Burkina Faso, demographics are changing and we are seeing a growing prevalence of older patients in intensive care units. Elderly people have increased health care needs but there is a lack of geriatric specialists. This study aimed to analyze in-hospital outcome of patients aged over 65 years, admitted to the Intensive Care Unit (ICU) at Yalgado Hospital.MethodsWe carried out a 5-year retrospective study in the ICU of Yalgado Ouédraogo Hospital. Elderly patients with completed records were included. Baseline characteristics, clinical and outcome were analyzed.ResultsTwo thousand one hundred sixteen patients were admitted to ICU, 237 (11.2%) of whom were included. There were 70 females and 167 males. The median age was 71.7 ± 6.1 years. The overall mortality rate in ICU was 73%, of whom 90% died within 7 days after admission. In multivariate analysis, shock (Odds Ratio: OR = 2.2, p = 0.002), severe brain trauma (OR; 9.6, p = 0.002), coma (OR 5.8 p < 0.003), surgical condition (OR = 4.2, p = 0.003), ASAPS Score ≥ 8 (OR = 4.3, p = 0.001), complication occurring (OR = 5.2, p = 0.001) and stroke (OR = 3.7, p = 0.001) were independent factors.ConclusionElderly patients were frequent in ICU and their mortality rate was high. Stroke, severe brain trauma, surgery, complications occurring during hospitalization were independent risk factors of death.

Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...

Background: Cancellation of scheduled surgery creates a financial burden for hospitals, caregivers and patients. Cancellation causes emotional stress, which impacts on outcomes. In poor countries where the adequacy of healthcare is limited, the ethical dilemma created by scheduled surgery cancellation is particularly important. Objective: To identify the incidence, cost and emotional impact of elective surgical cancellation in a teaching hospital in Burkino Faso. Methods: A four month, prospective, observational study was undertaken in a teaching hospital (Yalgado Ouedraogo). All surgical patients were eligible. The causes of cancellation, financial cost and patients' emotional response were assessed. The cost was estimated using a tool adapted for the economic cost of African job types. Results: During the study period, 1 088 cases were scheduled to undergo inpatient surgery. Of these, 239 cases (21.9%) were cancelled. Among the cancelled cases, 237 were cancelled during preparation in the surgical ward and two cases were cancelled in the operation room. A large number of the patients were housewives (n = 87). The highest cancellation rate (35.9%) was found in general surgery. Cancellation was judged avoidable in 214 cases (89.5%). The total cost of surgery cancellation to the hospital was US$ 19 147 (mean value US$ 80 per patient). Patients lost a mean of US$ 62.70, which represented 117.6% of the official average monthly income in Burkina Faso. ENT surgery was the costliest to the hospital (US$ 4 989 ). Cancellation caused a negative emotional reaction in 205 patients (85.7%) and 'sadness' was the most frequent (54.8%; n = 131). Cancellation resulted in 163 days of work lost. Conclusion: Based on income, the cost of day of surgery cancellation was high in Burkina Faso.

BackgroundHemorrhage is the main cause of maternal death during pregnancy. This study aims to evaluate incidence and outcomes of Severe Ante Partum Hemorrhage (SAPH) during the third trimester of pregnancy prior to delivery.MethodsAnalytical cross-sectional study with prospective data collection during 12 months in Yalgado Ouedraogo Hospital, Ouagadougou, Burkina Faso. In this context SAPH is specifically referring to Ante Partum Hemorrhage (APH) and Intra Partum Hemorrhage (IPH) in the 3rd trimester. Postpartum Hemorrhage (PPH) was not included.ResultsDuring our study 7,469 women were admitted in obstetrics and 122 cases of SAPH were recorded. SAPH represented 1.6% (n = 122) of hospitalizations causes and 14.5% (n = 1083) of hemorrhages during pregnancy. Mean age was 27.8 ± 6.9 years, mean parity 2.8 ± 1.3 and mean duration of pregnancy was 37 Weeks Amenorrhea (WA). Evacuation from other facilities was the main mode of admission (91.8%, n = 112) and blood transfusion was the essence of resuscitation. Complications were observed in 80.3% (n = 98). During the study, 118 maternal deaths were reported of which 15.6% (n = 19) related to SAPH. Among SAPH cases who died (n = 19) majority (n = 16) had severe anemia (n = 16; 82.6%, p = 0.004). Ten women (8.19%) were admitted in Intensive Care Unit (ICU). Fifteen premature births (12.3%) and 22 perinatal deaths (18.1%) were recorded. Evacuation (p = 0.04), critical clinical condition during admission (p = 0.004), and Uterine Rupture (UR) (p = 0.002) were associated with poor outcome. The Retroplacental Hemorrhage (RPH) (40.9%) was the most common cause of fetal death (p = 0.005) and was associated with High Blood Pressure (HBP) and pre-eclampsia.ConclusionAPH is a complication associated with significant maternal and fetal morbidity and mortality.