Bilan d’un an d’activite de neurochirurgie au Chu Kara

Introduction:  Le service de neurochirurgie du CHU Kara, 2ème au Togo, après celui de Lomé, situé à 430 Km. Après un an d’exercice, les auteurs font le bilan de leur activité neurochirurgicale. Patients et Méthode : Etude rétrospective, analytique et descriptive portant sur tous les patients qui ont été pris en charge dans le service de neurochirurgie. Les données démographiques, cliniques et thérapeutiques avaient été recueillies et analysées. Résultats : 471 patients avaient été pris en charge dont 198 femmes. La moyenne d’âge était de 37 ans avec des extrêmes allant de 04 jours à 85 ans. Le traumatisme crânien par accident de circulation à moto était le motif le plus fréquent de consultation. 18 patients étaient venus du Benin. 296 scanners avaient été réalisés en tout dont 229 au Benin. Sur 128 patients à évacuer sur la capitale, seuls 59 patients avaient pu être évacués. L’indication opératoire avait été posée pour 279 patients mais seulement 36 dont 15 femmes, se sont faits opérer. Les autres pour la majorité, ne sont jamais arrivés chez l’anesthésiste. 04 décès avaient été enregistrés en réanimation chirurgicale avant leurs évacuations sur Lomé.Conclusion : La pratique neurochirurgicale à Kara est très récente à Kara. Ilfaudra du temps et un travail de qualité malgré les conditions difficiles pourgagner la confiance des populations. Mots clés : bilan activité, neurochirurgie, Kara English Abstract: Assessment of one year of neurosurgery activity at Chu Kara Introduction: The neurosurgery department of CHU Kara, the second in neurosurgery in Togo, after that of the capital Lomé, located 430 km away. After a year of practice, the authors take stock of their neurosurgical activity. Patients and Method: Retrospective, analytical and descriptive study of all the patients who were treated in department of neurosurgery. Demographic, clinical and therapeutic data had been collected and analyzed. Results: 471 patients had been treated including 198 women. The average age was 37 years with extremes ranging from 04 days to 85 years. Head trauma from motorbike traffic accident was the most common reason for consultation. 18 patients had come from Benin. A total of 296 scanners were carried out, including 229 in Benin. Out of 128 patients to be evacuated to the capital, only 59 patients had been evacuated. The indication for surgery had been asked for 279 patients but only 36, including 15 women, had surgery. Most of the others never made it to the anesthesiologist. 04 deaths had been recorded in surgical resuscitation before their evacuations to Lomé. Conclusion: Neurosurgical practice in Kara is very recent in Kara. It will take time and quality work, despite the difficult conditions, to gain the trust of the populations. Keywords: activity assessment, neurosurgery, kar

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran