Perioperative outcomes of abdominal surgery in Ethiopia: a national clinical audit (2019–2024)   – Nature.Com 02:07 

Scientific Reports , Article number:  (2025) Cite this article

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Abstract

Perioperative complications remain a significant global concern, contributing substantially to disability, mortality, and economic loss, particularly in low- and middle-income countries (LMICs). This study utilized data from the National Perioperative Quality Improvement Network (NaPQIN) perioperative registry database in Ethiopia. We extracted data from 3226 abdominal surgical patients recorded in the NaPQIN perioperative registry database in Ethiopia. The median patient age was 34 years (Inter quartile range (IQR): 26–45 years), with a majority (55.8%, n = 1797) being male and classified American Society of Anesthesiologists (ASA) class I-II. The overall postoperative complication rate was 9.0% (290/3226), and the 30-day mortality rate was 1.50% (48/3226). The World Health Organization (WHO) Surgical Safety Checklist was utilized in 91.49% of procedures (2935/3226). Multivariable analysis identified significant associations between postoperative complications and both hypertension (adjusted odd ratio (AOR) = 2.61, 95% CI: 1.53–4.46, p < 0.001) and cancer (AOR = 2.53, 95% CI: 1.45–4.40, p = 0.001). Our findings indicate that approximately one in eleven patients undergoing abdominal surgery experiences a postoperative complication, and one in sixty-six dies before discharge. These results highlight the pressing need for evidence-based interventions to strengthen the foundation, care processes, and overall quality of the surgical system in Ethiopia.

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Data availability

Data collected for the study will be made available to others upon request to the corresponding author upon reasonable request.

Abbreviations

AOR:

adjusted odd ratioASA:

American Society of AnesthesiologistsASOS:

African Surgical Outcomes StudyERAS:

Enhanced Recovery After SurgeryISOS:

International Surgical Outcomes StudyLMICs:

low- and middle-income countriesMOH:

Ministry of Health (MOH)NaPQIN:

National Perioperative Quality Improvement NetworkNSOAP:

National Surgical, Obstetric, and Anesthesia PlanNSQIP:

National Surgical Quality Improvement ProgramPOMR:

postoperative mortality rateSaLTS:

Saving Lives Through Safe SurgerySSC:

Safety ChecklistSSI:

Surgical Site InfectionUHC:

Universal Health CoverageWHO:

World Health Organization

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Funding

Small grant from the QI- grant through Global Partners for Improving Surgical Systems/Network for perioperative and critical care (GPISS/N4PCc).

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Authors and Affiliations

  1. Department of Surgery, SOM, Debre Tabor University, Debre Tabor, EthiopiaAtalel Fentahun Awedew, Fisiha Guade Tesifaw & Amsalu Molla Getahun
  2. Global Partners for Improving Surgical System (GPISS), Project Network for Perioperative and Critical Care (GPISS-N4PCc), Addis Ababa, EthiopiaFitsum Kifle Belachew
  3. Department of Surgery, SOM, Debre Markos University, Debre Markos, EthiopiaMegbar Dessalegn Mekonnen
  4. Department of Orthopedics and Trauma Surgery, SOM, Mizan Tepi University, Mizan Tip, EthiopiaAdugnaw Bogale Worku
  5. Department of Anesthesia, Wolkite University, Wolkite, EthiopiaShamill Eanga Helill
  6. Department of Anesthesia, SOM, Mekele University, Mekele, EthiopiaMasresha Gebru Teklehaimanot
  7. Department of Anesthesia, Debre Berhan University, Debre Berhan, EthiopiaKokeb Desita Belihu
  8. Department of Anesthesiology and Critical Care, St. Paul’s Hospital Millenium Medical College, Addis Ababa, EthiopiaSamrawit Tassew Mekuria
  9. Department of Quality, St. Peter Specialized Hospital, Addis Ababa, EthiopiaBethelhem Muluye
  10. Department of Statistical and Data Governance, Global Partners for Improving Surgical System (GPISS), Project Network for Perioperative and Critical Care (GPISS-N4PCc), Addis Ababa, EthiopiaKalkidan Kifle & Tesfaye Yohannes

Contributions

AF, AM, FG, MD, MG: Conceptualization and draft writingFK, KD: Leadership and reviewingKK, TY, BM: Data extraction, standardization and prepare for analysisAF, TY: Methodology and analysisAF, FG, AM, BM, AB, SE KD, ST, KK, TY, MD, FK, MG : Manuscript writing, review and approval.

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Correspondence to Atalel Fentahun Awedew.

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The authors declare no competing interests.

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Awedew, A.F., Belachew, F.K., Mekonnen, M.D. et al. Perioperative outcomes of abdominal surgery in Ethiopia: a national clinical audit (2019–2024). Sci Rep (2025). https://doi.org/10.1038/s41598-025-30626-w

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