Vol. 225, No.
4S1, October 2017
RESULTS: There were 241 patients who presented to KCH with
TBI requiring higher-level care, with a total mortality of 16.4%;
163 (68%) underwent EBH, with a mortality of 6.8%. Mortality
in patients who did not undergo EBH was 43.9%. Upon logistic
regression adjusted for age, sex, and Glasgow Coma Score, not un-
dergoing EBH significantly increased the odds of mortality (odds
ratio 12.0, p ¼ 0.000, 95% CI 4.48e31.9). Of patients who
underwent EBH, 87.6% of patients had intraoperative findings,
with subdural hematoma being the most common (51.2%).
CONCLUSIONS: EBH remain an important diagnostic and ther-
apeutic procedure for TBI in LMICs. In the absence of a neurosur-
geon, EBH technique should be taught to general surgeons to
attenuate TBI-related mortality.
Perioperative Mortality Rates: A Systematic
Review and Meta-Analysis of the Literature
from Low- and Middle-Income Countries
Joshua Ng-Kamstra, MPH, Sumedha Arya, Sarah L Greenberg, MD,
Meera Kotagal, MD, MPH, John G Meara, MD, FACS,
Mark G Shrime, MD, MPH, FACS, International Perioperative
Mortality Review Group
Harvard Medical School, Boston Children’s Hospital Boston,
MA
INTRODUCTION: Avoiding the catastrophic outcome of dying
after surgery is a shared priority of patients, care providers, and
policymakers. To decrease perioperative mortality rates (POMR)
at a health-system level, a better understanding of what drives these
rates across procedures and country contexts is imperative. We
undertook a systematic review and meta-analysis of POMR in
low- and middle-income countries (LMICs).
METHODS: We searched PubMed, EMBASE, LILACS, Web of
Science, African Index Medicus, and the WHO global health
library for studies reporting POMR in LMICs published between
January 1, 2009, and December 31, 2014. We extracted definitions
of POMR, procedure type, case urgency, and the reported mortal-
ity rate in duplicate from each included study.
RESULTS: From 7,701 nonduplicate citations found, abstract
screening yielded 1,595 studies warranting full-text review. We
included 984 studies examining mortality across 192 procedure
or diagnostic groups. Collectively, these studies represented
1,020,657 patients. Inguinal hernia infrequently led to surgical
mortality (0.4%, 95% CI 0e1.2); death was common after surgery
for typhoid intestinal perforation (20.1%, 14.4e26.5). POMR
after emergency peripartum hysterectomy was similar in
low-income countries (10.3%, 6.5e15.9, n ¼ 1) and lower-middle
income countries (10.7%, 8.0e13.7, n ¼ 22), and lower in upper-
middle income countries (4.1%, 1.8e7.0, n ¼ 15).
CONCLUSIONS: Given the wide variation in POMR by proced-
ure, policymakers must contextualize system-level POMR with a
description of the types of procedures performed. This will allow
for appropriate benchmarking that accounts for a population’s
specific spectrum of surgical disease.
Downloaded for Anonymous User (n/a) at Universitas Gadjah Mada from ClinicalKey.com by Elsevier on January 27, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
Scientific Forum Abstracts S107
Pre-Existing Malnutrition Increases Operative
Mortality in a Sub-Saharan Africa Burn Unit
Joanna Grudziak, MD, Carolyn Snock, Tayamika Zalinga Phiri,
Jared R Gallaher, MD, MPH, Bruce A Cairns, MD, FACS,
Anthony G Charles, MBBS, FACS
University of North Carolina-Chapel Hill, Chapel Hill, NC,
Kamuzu Central Hospital, Lilongwe, Malawi
INTRODUCTION: We have shown that delaying operative inter-
vention improves patient survival in our Sub-Saharan burn unit.
Literature from the developed world shows that pre-existing
malnutrition worsens burn injury outcomes. Studies on the influ-
ence of malnutrition on operative outcomes in burn patients in
resource-poor settings are lacking.
METHODS: This is a retrospective review of operative patients
admitted to our burn unit from July 2011 to May 2016. Age-
adjusted Z scores were calculated for height, weight, weight for
height, and mid-upper arm circumference (MUAC) (Figure). A
fully adjusted logistic regression model of predictors of operative
mortality was constructed.
RESULTS: There were 393 of 1,353 patients who received oper-
ative intervention (29%); 52.2% were male, median age was 6
years, and 265 patients (68%) were under 16 years old. The me-
dian total body surface area (TBSA) was 16%. Open flames caused
the majority of burns (64%). Overall operative mortality was
14.7%, increasing to 33.3% for adults aged 51 and over. Delayed
operative intervention was protective (odds ratio [OR] 0.89, 95%
CI 0.82, 0.97). Increasing % TBSA burned (OR: 1.11, 95% CI:
1.05, 1.17) and increasing severity of malnutrition (OR 1.39,
95% CI 1.01, 1.90) increased odds of death in the adjusted multi-
variate model. Only % TBSA burned predicted mortality in the
older patients (OR 1.22, 95% CI 0.99, 1.50).
CONCLUSIONS: Malnutrition is an important risk factor for
operative mortality following burn injury in resource-poor settings,
particularly in children. Routine malnutrition screening, nutri-
tional evaluation, and supplementation are therefore mandatory
in burn units in resource-poor settings.