{
  "abstract": "Objectives To assess the outcomes of patients undergoing open abdominal surgery at a National Referral Hospital in Tanzania.Design A prospective, observational, single-arm cohort study.Setting Dar es Salaam, Tanzania.Participants Patients who underwent open abdominal surgery between August 2022 and July 2023 were included. Patients were enrolled if they provided informed consent to participate and were ≥18 years of age. Patients were excluded if they were lost to follow-up, were admitted outside the department of surgery or were still admitted since the index surgery at the end of the study.Main outcome measures The primary outcome was a composite measurement of mortality that includes patients who died during the index admission and those who died up to 30 days postdischarge. Secondary outcomes included surgical complications, unplanned readmissions, economic burden and functional outcomes. Clinically relevant factors identified a priori and with a p value of ≤0.2 in the univariable model were tested in a multivariable logistic regression to identify independent risk factors for composite mortality, with backward stepwise elimination using a statistical significance set at a p value <0.05 and 95% CI not including 1.0.Results Of 626 patients who had an open abdominal surgery, 555 (88.7%) met the inclusion criteria, of which 120 (21.6%) died. Of the deaths, 61 (51%) occurred during the index admission, 48 (40%) outside the hospital and 11 (9%) following unplanned readmission. Among the surviving 435 (78%) patients who participated in the 30-day follow-up, those without insurance were less likely to return to work (7.3% vs 16% insured) and had higher out-of-pocket expenses ($321 vs $82 insured).Conclusions Open abdominal surgery carries a composite mortality rate of 22% with almost half of deaths occurring after index hospital discharge. These findings underscore the need for routine follow-up, early complication identification and management and universal health coverage to improve outcomes, and reduce financial hardships.",
  "authors": [
    {
      "affiliations": [
        "Department of Surgery, University of California San Francisco, San Francisco, California, USA",
        "Department of Surgery, University of New Mexico, Albuquerque, NM, USA",
        "Center for Health Equity in Surgery and Anesthesia, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA"
      ],
      "name": "Nathan Brand"
    },
    {
      "affiliations": [
        "Center for Health Equity in Surgery and Anesthesia, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA",
        "Department of Surgery, Muhimbili University for Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Larry Akoko"
    },
    {
      "affiliations": [
        "Center for Health Equity in Surgery and Anesthesia, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA",
        "Department of Surgery, Muhimbili University for Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Emmanuel Obedi"
    },
    {
      "affiliations": [
        "Center for Health Equity in Surgery and Anesthesia, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA",
        "Department of Surgery, Muhimbili University for Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Ally Mwanga"
    },
    {
      "affiliations": [
        "Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of",
        "The Branch for Global Surgical Care, University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Godfrey Sama Philipo"
    },
    {
      "affiliations": [
        "Department of Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania, United Republic of"
      ],
      "name": "Charles Komba"
    },
    {
      "affiliations": [
        "Department of Surgery, University of California San Francisco, San Francisco, California, USA",
        "Center for Health Equity in Surgery and Anesthesia, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA"
      ],
      "name": "Marissa Boeck"
    }
  ],
  "title": "Outcomes of open abdominal surgery at a single-centre tertiary referral hospital in Tanzania: a prospective, observational, single-arm cohort study",
  "uid": "305eb885-16f6-5f5a-80f4-50ec82ec397b"
}