Taylor Wurdeman, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA; University of Miami Miller School of Medicine, Miami, FL, USA
Christopher Strader, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA; Department of Surgery, University of Massachusetts, Worcester, MA, USA
Shehnaz Alidina, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
David Barash, GE Foundation, Boston, MA, USA
Isabelle Citron, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
Ntuli Kapologwe, Department of Health, Social Welfare and Nutrition Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
Erastus Maina, Dalberg Advisors, New York, NY, USA
Fabian Massaga, Bugando Medical Centre, Consultant and Teaching University Hospital, Mwanza, Tanzania
Adelina Mazhiqi, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA; Department of Internal Medicine, Ängelholm Hospital, Ängelholm, Sweden
John G. Meara, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
Gopal Menon, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
Cheri Reynolds, Assist International, Ripon, CA, USA
Meaghan Sydlowski, Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
John Varallo, Jhpiego, Baltimore, MD, USA
Sarah Maongezi, Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania
Mpoki Ulisubisya, Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania

Document Type

Article

Publication Date

1-1-2021

Abstract

BACKGROUND: Postoperative mortality rate is one of six surgical indicators identified by the Lancet Commission on Global Surgery for monitoring access to high-quality surgical care. The primary aim of this study was to measure the postoperative mortality rate in Tanzania's Lake Zone to provide a baseline for surgical strengthening efforts. The secondary aim was to measure the effect of Safe Surgery 2020, a multi-component intervention to improve surgical quality, on postoperative mortality after 10 months.

METHODS: We prospectively collected data on postoperative mortality from 20 health centers, district hospitals, and regional hospitals in Tanzania's Lake Zone over two time periods: pre-intervention (February to April 2018) and post-intervention (March to May 2019). We analyzed postoperative mortality rates by procedure type. We used logistic regression to determine the impact of Safe Surgery 2020 on postoperative mortality.

RESULTS: The overall average in-hospital non-obstetric postoperative mortality rate for all surgery procedures was 2.62%. The postoperative mortality rates for laparotomy were 3.92% and for cesarean delivery was 0.24%. Logistic regression demonstrated no difference in the postoperative mortality rate after the Safe Surgery 2020 intervention.

CONCLUSIONS: Our results inform national surgical planning in Tanzania by providing a sub-national baseline estimate of postoperative mortality rates for multiple surgical procedures and serve as a basis from which to measure the impact of future surgical quality interventions. Our study showed no improvement in postoperative mortality after implementation of Safe Surgery 2020, possibly due to low power to detect change.

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