Fools rush in where angels fear to tread
Despite advances in medical therapies, surgery remains a key component of the treatment for many diseases. Each year, more than 300 million surgical procedures are performed worldwide, even though much of the global population is unable to access surgical treatments.1,2 As the Lancet Commission on Global Surgery gains traction, we will see a substantial increase in the number of surgical procedures performed in low and middle income countries.3,4 This improvement is undoubtedly welcome, yet as anaesthetists we can expect significant new challenges to result. In 2018, a seminal work by the African Surgical Outcomes Study group transformed our understanding of postoperative outcomes in African countries.5 We now know that surgical patients in Africa are twice as likely to die after surgery even though they are younger, fitter and develop fewer complications. The new challenge is ‘failure to rescue’ or the undetected physiological deterioration of patients on the ward after surgery. As we succeed in extending access to surgical treatments in Africa, we must expect the absolute number of postoperative deaths to rise. The benefits of access to surgery cannot be fully realised unless these treatments are safe. In high income countries, this problem has been well described and tackled through various measures from staff education to support teams such as critical care outreach.6 Similar strategies can and will allow us to resolve this problem in Africa, but research is urgently needed to determine the best approach for a resource poor context.
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