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Background Multimorbidity, particularly prevalent among older patients, represents a growing global health challenge. This study investigates the prevalence of multimorbidity and its relationship with perioperative outcomes among older patients undergoing major surgery in Ethiopia. Methods This longitudinal study was conducted at a tertiary teaching hospital in Northwest Ethiopia from June 01, 2019, to June 30, 2021. All consecutive older (aged 50+) patients who underwent major surgery during the study period were included. The primary outcome measure was estimating the prevalence of multimorbidity. Secondary outcome measures were the association between multimorbidity and 28-day perioperative mortality and length of hospital stay. A bivariable and multivariable modified Poisson regression was used to compute crude and adjusted relative risks, respectively, along with 95% confidence intervals (CIs) to assess the strength of association while adjusting for confounding covariates. A p -value < 0.05 was used to declare statistical significance. Results Of 874 patients who underwent major surgery, 234 (26.77%) patients had one comorbidity, and 94 (10.76%) patients had multimorbidity. Among all geriatric patients, 130 (14.87%) had hypertension, 34 (3.89%) had diabetes mellitus, and 29 (3.32%) had cancer. The most common multimorbidity combination was hypertension and diabetes (18 cases). The rates of perioperative mortality were higher in patients with multimorbidity compared with those with either one or no comorbidity (36.46% vs. 33.33% vs. 28.21%; p  < 0.001). The risk of perioperative mortality after surgery among patients with multimorbidity was more than eight (adjusted relative risk = 8.07, 95% CI:2.39, 27.23) times higher than that of those with no comorbidity. Conclusion Multimorbidity in older surgical patients was common, and one in ten older patients undergoing major surgery had multimorbidity. Multimorbidity increases the risk of mortality among older patients following major surgery. We recommend targeted management of older surgical patients with multimorbidity by preoperative screening and optimization before surgery.

Objective To identify the determinants of 28-day perioperative mortality and postoperative length of hospital stay among geriatric patients. Design and setting A prospective, two-center follow-up study conducted at two tertiary referral hospitals in Ethiopia. Participants A total of 1014 consecutive geriatric patients who underwent surgery between January 2019 and January 2022 were included. Results This study documented a 28-day perioperative mortality rate of 2.86% (95% CI: 1.9–4.0) and a median postoperative length of hospital stay of six days. Multivariable analyses identified independent determinants for each outcome. For 28-day perioperative mortality, Cox proportional hazards regression revealed significant associations with the presence of comorbidities (aHR = 3.10) and the use of general anesthesia (aHR = 6.12). Determinants of extended postoperative length of hospital stay, evaluated using negative binomial regression, included the following: comorbidities (aIRR= 1.31), emergency surgery (aIRR = 1.28), and higher American Society of Anesthesiologists (ASA) physical status classification (ASA II: aIRR = 1.31; ASA ≥ III: aIRR = 1.38), each additional 60 minutes of anesthesia duration (aIRR = 1.15), and intraoperative blood loss (>500 mL; aIRR = 1.27). Conversely, each 1 g/dL increase in preoperative hemoglobin was found to be protective (aIRR = 0.97). Conclusion This study identifies key modifiable determinants of adverse postoperative outcomes in geriatric surgical patients. The 28-day perioperative mortality was strongly associated with general anesthesia and preexisting comorbidities. The postoperative length of hospital stay was influenced by a broader set of variables, including patient factors, surgical urgency, and procedural complexity. These findings highlight critical targets for quality improvement in low-resource settings.

Point-of-care ultrasound (POCUS) is a transformative tool for anesthesiology in low- and middle-income countries (LMICs), where limited access to advanced medical imaging, unreliable power, and scarce resources hinder patient care. This technology's portability, affordability, and diagnostic versatility address critical gaps, enabling better preoperative assessment, intraoperative monitoring, and emergency interventions. POCUS facilitates procedures such as catheter placement and nerve blocks, diagnoses conditions such as pneumothorax, and evaluates cardiac function, all without ionizing radiation. Training initiatives, including hands-on workshops and tele-mentoring, empower providers in resource-limited settings. By integrating POCUS into anesthesiology practices, LMICs can enhance patient outcomes and elevate healthcare delivery.

IntroductionThe paucity of data on perioperative outcomes in low- and middle-income countries complicates the design and implementation of targeted interventions to improve the delivery of safe, affordable, accessible and timely surgical and anaesthesia care services. We assessed perioperative outcomes of patients undergoing surgical care at three Rwandan rural hospitals—Butaro District Hospital, Kirehe District Hospital and Rwinkwavu District Hospital—supported by Partners In Health/Inshuti Mu Buzima—an international non-governmental organisation.MethodsWe conducted a 6-month prospective observational cohort study at the three district hospitals. A validated electronic-based perioperative assessment tool was adapted for our setting to capture demographics and clinical information. Descriptive and logistic regression analyses were performed using Stata V.15.1.ResultsA total of 3289 major surgeries were performed from January to September 2020 at the three hospitals. Overall, 3204 surgeries (97.5%) were performed on women; the median age was 27 years (IQR: 23–33), and emergency cases constituted 86.8% of all cases. Cases with the American Society of Anesthesiologists (ASA) status of 3 or above had higher odds of having surgical or anaesthesia complications compared with cases with ASA status 1 (OR: 11.1, 95% CI: 2.7 to 45.8). Furthermore, emergency cases had 1.8 times higher odds of having a composite outcome (developing complications, surgical site infections or death) compared with elective cases (95% CI: 1.1 to 3.0).ConclusionOur findings highlight the need for improving surgical capacity, reinforcing infection prevention and control measures and leveraging electronic data capture for quality improvement to ensure safer surgery and anaesthesia care in rural Rwanda.

Background Anesthesiologists administer excess supplemental oxygen (hyper-oxygenation) to patients during surgery to avoid hypoxia. Hyper-oxygenation, however, may increase the generation of reactive oxygen species and cause oxidative damage. In cardiac surgery, increased oxidative damage has been associated with postoperative kidney and brain injury. We hypothesize that maintenance of normoxia during cardiac surgery (physiologic oxygenation) decreases kidney injury and oxidative damage compared to hyper-oxygenation. Methods/design The Risk of Oxygen during Cardiac Surgery (ROCS) trial will randomly assign 200 cardiac surgery patients to receive physiologic oxygenation, defined as the lowest fraction of inspired oxygen (FIO 2 ) necessary to maintain an arterial hemoglobin saturation of 95 to 97%, or hyper-oxygenation (FIO 2  = 1.0) during surgery. The primary clinical endpoint is serum creatinine change from baseline to postoperative day 2, and the primary mechanism endpoint is change in plasma concentrations of F 2 -isoprostanes and isofurans. Secondary endpoints include superoxide production, clinical delirium, myocardial injury, and length of stay. An endothelial function substudy will examine the effects of oxygen treatment and oxidative stress on endothelial function, measured using flow mediated dilation, peripheral arterial tonometry, and wire tension myography of epicardial fat arterioles. Discussion The ROCS trial will test the hypothesis that intraoperative physiologic oxygenation decreases oxidative damage and organ injury compared to hyper-oxygenation in patients undergoing cardiac surgery. Trial registration ClinicalTrials.gov, ID: NCT02361944 . Registered on the 30th of January 2015.

Findings from the ARISE and TRISS trials indicate that protocolized therapy might be no better than contemporary management for patients in intensive care, and that in the absence of coronary disease a haemoglobin level of 70 g/l should be the new trigger for transfusion in patients with sepsis.

Purpose Lack of access to safe and affordable anesthesia and monitoring equipment may contribute to higher rates of morbidity and mortality in low- and middle-income countries (LMICs). While capnography is standard in high-income countries, use in LMICs is not well studied. We evaluated the association of capnography use with patient and procedure-related characteristics, as well as the association of capnography use and mortality in a cohort of patients from Kenya and Ethiopia. Methods For this retrospective observational study, we used historical cohort data from Kenya and Ethiopia from 2014 to 2020. Logistic regression was used to study the association of capnography use (primary outcome) with patient/procedure factors, and the adjusted association of intraoperative, 24-hr, and seven-day mortality (secondary outcomes) with capnography use. Results A total of 61,792 anesthetic cases were included in this study. Tertiary or secondary hospital type (compared with primary) was strongly associated with use of capnography (odds ratio [OR], 6.27; 95% confidence interval [CI], 5.67 to 6.93 and OR, 6.88; 95% CI, 6.40 to 7.40, respectively), as was general ( vs regional) anesthesia (OR, 4.83; 95% CI, 4.41 to 5.28). Capnography use was significantly associated with lower odds of intraoperative mortality in patients who underwent general anesthesia (OR, 0.31; 95% CI, 0.17 to 0.48). Nevertheless, fully-adjusted models for 24-hr and seven-day mortality showed no evidence of association with capnography. Conclusion Capnography use in LMICs is substantially lower compared with other standard anesthesia monitors. Capnography was used at higher rates in tertiary centres and with patients undergoing general anesthesia. While this study revealed decreased odds of intraoperative mortality with capnography use, further studies need to confirm these findings.

Lack of access to safe and affordable anesthesia and monitoring equipment may contribute to higher rates of morbidity and mortality in low- and middle-income countries (LMICs). While capnography is standard in high-income countries, use in LMICs is not well studied. We evaluated the association of capnography use with patient and procedure-related characteristics, as well as the association of capnography use and mortality in a cohort of patients from Kenya and Ethiopia. For this retrospective observational study, we used historical cohort data from Kenya and Ethiopia from 2014 to 2020. Logistic regression was used to study the association of capnography use (primary outcome) with patient/procedure factors, and the adjusted association of intraoperative, 24-hr, and seven-day mortality (secondary outcomes) with capnography use. A total of 61,792 anesthetic cases were included in this study. Tertiary or secondary hospital type (compared with primary) was strongly associated with use of capnography (odds ratio [OR], 6.27; 95% confidence interval [CI], 5.67 to 6.93 and OR, 6.88; 95% CI, 6.40 to 7.40, respectively), as was general (vs regional) anesthesia (OR, 4.83; 95% CI, 4.41 to 5.28). Capnography use was significantly associated with lower odds of intraoperative mortality in patients who underwent general anesthesia (OR, 0.31; 95% CI, 0.17 to 0.48). Nevertheless, fully-adjusted models for 24-hr and seven-day mortality showed no evidence of association with capnography. Capnography use in LMICs is substantially lower compared with other standard anesthesia monitors. Capnography was used at higher rates in tertiary centres and with patients undergoing general anesthesia. While this study revealed decreased odds of intraoperative mortality with capnography use, further studies need to confirm these findings.