# Adoption, Impact, and Economic Considerations of Pulse Oximetry and Oxygen Systems in African Surgical Care: A Narrative Review

## TL;DR

This paper reviews how pulse oximetry and oxygen systems are used in African surgical care, highlighting their importance, current adoption challenges, and economic benefits.

## Contribution

The paper provides a narrative review of the adoption and impact of pulse oximetry and oxygen systems in African surgical settings, emphasizing economic and clinical outcomes.

## Key findings

- Pulse oximetry and oxygen systems improve perioperative safety and reduce complications when combined with training and checklists.
- Oxygen concentrators and PSA plants enhance operating theater productivity and reduce case cancellations.
- Economic models show these systems can be cost-effective in African settings, with costs below USD 100 per DALY averted.

## Abstract

Reliable medical oxygen and pulse oximetry are fundamental safety components of modern anesthetic practice, providing continuous monitoring and treatment of hypoxemia. Although the World Health Organization (WHO) surgical safety checklist is widely endorsed, many African hospitals still cannot rely on functional pulse oximeters and a stable oxygen supply. These gaps are associated with avoidable perioperative injuries and preventable morbidity and mortality.

To evaluate the prevailing adoption, clinical-level, and economic implications of oximetry and oxygen systems in the African surgical pathways, we conducted a narrative review of peer-reviewed articles and grey literature (PubMed/MEDLINE, Scopus, WHO Institutional Repository for Information Sharing (IRIS); last search October 9, 2025). The inclusion criteria focused on African studies reporting perioperative settings (e.g., operating theaters, recovery areas, surgical wards), clinical outcomes, and data on economics or programme sustainability.

The adoption has improved, although the functional readiness is still less than optimal, as most of the district hospitals indicate non-functional devices, frequent power disruptions, and insufficient maintenance. The use of continuous oximetry aids in the early identification of hypoxemia, and when combined with checklists and training teams, it is linked to a lower number of anesthesia-related complications and improved postoperative monitoring. Enhancing oxygen facilities in the form of concentrators, pipelines, and pressure swing adsorption (PSA) plants is associated with fewer case cancellations and other positive effects on the productivity of the operating theater. Economic modeling studies suggest that pulse oximetry and oxygen systems can be highly cost-effective in selected African settings, with estimated costs below USD 100 per disability-adjusted life year (DALY) averted under specific assumptions. National oxygen programs have been found to have a high uptime when the life-cycle costs and maintenance budgets are planned properly. The issues with the sensor performance in darker skin colors highlight the necessity of having a strict set of procurement rules and excellent quality control.

High-value, viable safety investments in oximetry and dependable oxygen provision can boost perioperative care and health system efficiency in Africa. Sustainable gains are achieved when equipment scale-up is integrated with extensive training, preventive maintenance, and data systems that correspond to the National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) and the WHO Regional Office for Africa (AFRO) schemes. The priorities to be put forward in future work should be equity-intensive device validation, bundled effectiveness-implementation trials, and context-dependent cost examinations to guide the national planning.