Perioperative Management and Outcomes of Open Aortic Aneurysm Repair in Ethiopia

TL;DR

This study examines the outcomes of open aortic aneurysm surgery in Ethiopia, highlighting challenges like limited resources and high complication rates.

Contribution

The study provides insights into open aortic aneurysm repair in a low-resource setting, emphasizing unique challenges and outcomes in Ethiopia.

Findings

In-hospital mortality was 13.3% with 37.8% experiencing major complications.

Ischemic heart disease and prolonged cross-clamp time were significant risk factors for mortality and complications.

Resource shortages hindered perioperative care and impacted surgical outcomes.

Abstract

Background

Aortic aneurysms (AAs) are life-threatening conditions requiring timely surgical intervention. While endovascular repair is most common in high-income countries, open surgical repair (OSR) remains the only option in low-resource settings like Ethiopia. This study aimed to examine patient characteristics, perioperative management, and outcomes of OSR at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia.

Methods

We conducted a retrospective observational study of adult patients who underwent OSR between January 2017 and May 2024. Data were extracted from the operating room (OR) logbook and surgical intensive care unit (SICU) registry using a structured tool. Descriptive statistics summarized patient characteristics and perioperative care, while logistic regression analyses identified predictors of in-hospital mortality and major complications. Statistical significance was set at p < 0.05.

Results

A total of 45 patients (mean age 54.4 ± 16.3 years; 57.8% female) were included in the study. Most had abdominal aneurysms (88.9%) and underwent elective surgery. In-hospital mortality was 13.3%, and 37.8% experienced major complications, excluding deaths. Acute kidney injury (AKI, 22.2%) and hospital-acquired pneumonia (15.8%) were the most common. Ischemic heart disease (IHD) was notably associated with increased risk of mortality (crude odds ratio (COR) = 9.25; p = 0.080), AKI (COR = 14.57; p = 0.030), and respiratory complications (COR = 27.75; p = 0.009). A cross-clamp time exceeding 90 minutes was significantly associated with increased mortality (COR = 7.75; p = 0.035) and AKI (COR = 7.25; p = 0.013). Elevated baseline serum creatinine (≥1 mg/dL) was also significantly associated with the development of AKI (COR = 22.67; p = 0.006).

Conclusion

This study highlights the feasibility and challenges of open AA repair in resource-limited Ethiopia. Despite a few cases, younger, low-comorbidity patients reflect selective surgery due to constraints. Shortages in equipment, medications, and ICU beds significantly hindered perioperative monitoring, anesthesia care, and pain management, impacting overall surgical outcomes.