Fools rush in where angels fear to tread
Keywords:Surgery, Postoperative care/methods, Surgical Procedures, Operative/mortality
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.
By submitting manuscripts to SAJAA, authors of original articles are assigning copyright to the SA Society of Anaesthesiologists. Authors may use their own work after publication without written permission, provided they acknowledge the original source. Individuals and academic institutions may freely copy and distribute articles published in SAJAA for educational and research purposes without obtaining permission.
The work is licensed under a Creative Commons Attribution-Non-Commercial Works 4.0 South Africa License. The SAJAA does not hold itself responsible for statements made by the authors.