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. 2024 Nov 12;24(1):3139.
doi: 10.1186/s12889-024-20678-4.

The effect of comorbidity on 28-day perioperative mortality rate among non-cardiac surgical patients in Northwest Ethiopia: a prospective cohort study using propensity score matching

Amanuel Sisay Endeshaw  1 , Eshetu Tesfaye Dejen  2 , Fantahun Tarekegn Kumie  2
Affiliations

The effect of comorbidity on 28-day perioperative mortality rate among non-cardiac surgical patients in Northwest Ethiopia: a prospective cohort study using propensity score matching

Amanuel Sisay Endeshaw et al. BMC Public Health. .

Abstract

Background: Non-communicable diseases account for nearly three-fourths of global deaths impacting public health and development. Coexisting diseases can complicate the management of surgical diseases, increasing the risk of perioperative mortality. Despite this, few studies have examined the burden of comorbidities among surgical patients and their effect on perioperative outcomes in low-income countries. In this study, we assessed the impact of comorbidity burden on 28-day perioperative mortality using a prospective data set.

Methods: This was a facility-based prospective cohort study. Adult patients aged ≥ 18 who underwent non-cardiac surgery were included. Patients were followed for 28 days following surgery. Perioperative data were collected using an electronic data collection system from June 01, 2019, to June 30, 2021, at Tibebe Ghion Specialized Hospital, Northwest, Ethiopia. A propensity score-matched analysis was employed to assess the effect of comorbidity on the 28-day perioperative mortality rate.

Results: Of the 3030 patients included in this study, 715 (23.59%) had at least one comorbidity. Based on the prevalence rate, the top four comorbid conditions observed were hypertension (0.050), cancer (0.036), diabetes mellitus (0.021), and human immunodeficiency virus (0.021). The 28-day perioperative mortality rate was shown to be significantly higher among patients with comorbidity, where 45 (6.29%) of the 715 patients with comorbidity died compared to 49 (2.12%) of the 2315 patients with no comorbidity (p-value < 0.0001). After propensity score matching potential confounders, patients who have comorbidity had a 2.52% (average treatment effect on treated (ATT) = 0.0252) higher risk of perioperative death at 28 days after surgery compared with patients who did not have comorbidity.

Conclusion: This study found a moderate prevalence of comorbid illnesses among non-cardiac surgical patients, with comorbidity increasing the risk of 28-day perioperative mortality. Preoperative screening and optimization are highly recommended for patients with comorbid illness to decrease perioperative mortality rate.

Keywords: Comorbidity; Ethiopia; Outcome; Perioperative mortality; Surgery.

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Conflict of interest statement

Declarations Ethical approval and consent to participate The institutional review board (IRB) of the College of Medicine and Health Science, Bahir Dar University (reference number: 0163/2018) approved the protocol to conduct this study. The need for written informed consent was waived for all study subjects by the institutional review board (IRB) of the College of Medicine and Health Science, Bahir Dar University and Tibebe Ghion Specialized Hospital since the study included emergency and critical patients. During follow-up phone calls oral consent to participate in the study was obtained from patients or family members. The confidentiality and security of all patient information were maintained to prevent unauthorized access. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart showing number of surgical cases included in the study
Fig. 2
Fig. 2
Pattern of comorbidities among non-cardiac surgical patients, June 2019–June 2021
Fig. 3
Fig. 3
Histogram of propensity scores of comorbidities to show common support
See this image and copyright information in PMC

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