Postoperative Mortality in Digestive Surgery in a Low-Resource Setting: A Five-Year Multicentre Study from Cameroon

Abstract

Background: Postoperative mortality after digestive surgery remains disproportionately high in low-resource settings, particularly in sub-Saharan Africa. Evidence from Cameroon remains limited despite a substantial burden of digestive surgical disease. Objective: To determine the prevalence, characteristics, causes, and predictors of postoperative mortality after digestive surgery in two tertiary hospitals in Cameroon. Methods: A retrospective multicentre observational study was conducted at Yaoundé Central Hospital and Yaoundé Emergency Centre between January 2020 and December 2024. All adult patients undergoing digestive surgery were included. Postoperative mortality was defined as death within 30 days after surgery. Digestive surgical procedures were categorized according to the underlying pathology and type of operation in order to better describe the case-mix of the study population. Complications were defined as any adverse clinical event occurring within 30 postoperative days or during the index hospital admission. Multivariate logistic regression was used to identify independent predictors of mortality. Results: Among 505 digestive surgical procedures, 96 postoperative deaths occurred, corresponding to a mortality rate of 19.0%. Mortality was 17.0% after elective surgery and 20.0% after emergency procedures. The surgical case-mix was dominated by emergency abdominal conditions including generalized peritonitis due to gastrointestinal perforation, intestinal obstruction, complicated appendicitis, traumatic abdominal injuries, and digestive malignancies. Early deaths (<48 h) accounted for 38.5% of cases. Septic shock was the leading cause of death (30.2%). Independent predictors of mortality included age ≥ 60 years (OR 1.62, 95% CI 1.00–2.60), ASA ≥ 3 (OR 3.35, 95% CI 2.11 - 5.30), delayed surgery > 24 h (OR 2.88, 95% CI 1.70 - 4.90), and postoperative complications (OR 5.40, 95% CI 2.80 - 10.40). Conclusion: Postoperative mortality after digestive surgery is markedly high in this low-resource setting and is primarily driven by delayed care, advanced disease severity, and septic complications. Strengthening perioperative and emergency surgical systems is essential to reduce digestive surgical mortality in sub-Saharan Africa.