Abstract
Background
Providing critical care is essential for improving health outcomes, particularly in low-resource settings such as the Democratic Republic of the Congo (DRC). However, there is a significant lack of data regarding the management and outcomes of critically ill surgical patients in this region. This study aimed to investigate the factors associated with mortality among surgical patients admitted to the intensive care unit (ICU) at HEAL Africa Hospital in eastern DRC.
Methods
This retrospective cross-sectional study analyzed data from surgical patients admitted to the ICU between January 2021 and June 2023. Information was extracted from the ICU registry, including demographics, reasons for admission, management details, length of stay, and mortality rates. Categorical data were presented as frequencies, and logistic regression was used, with a p-value of less than 0.05 considered significant.
Results
Out of 807 patients admitted to the ICU, 368 were surgical patients (43.12%). The cohort had a male predominance (1.6:1) with a median age of 31 years. The primary reason for admission was postoperative monitoring (57.2%). The overall mortality rate was 21.3%. Univariate analysis identified statistically significant risk factors for increased mortality: male sex (p = 0.004), age (p = 0.0409), need for mechanical ventilation (p < 0.0001), involvement in neurosurgery (p = 0.03), and non-operative management (p < 0.0001). Multivariate analysis confirmed that the need for mechanical ventilation (p < 0.0001) and the non-operative management (p < 0.0001) was significantly associated with increased mortality.
Conclusion
The burden of surgical critically ill patients in eastern DRC is substantial. Non-operative management and the requirement for mechanical ventilation were identified as factors influencing mortality among these patients. To tackle this pressing issue, it is essential to enhance critical care protocols, invest in the training of healthcare professionals, and allocate resources effectively.
Clinical trial number
Not applicable.
Keywords: Intensive care unit, Heal Africa hospital, Mortality, Critical surgical patient
Background
The Intensive Care Unit (ICU) is a specialized department where critically ill patients receive continuous monitoring and treatment around the clock. Its primary objective is to restore and sustain the function of vital organs, thereby enhancing the likelihood of survival. This unit is regarded as a central hub, capable of accommodating patients from various medical specialties [1–3].
To ensure the provision of high-quality primary healthcare, it is crucial to integrate emergency services, critical care, and surgical care [4]. An effectively organized system of these services is crucial for achieving the diverse objectives linked to the third Sustainable Development Goal, which seeks to ensure healthy lives and promote well-being for everyone, particularly in relation to universal health coverage [4, 5]. Most healthcare facilities in sub-Saharan Africa lack intensive care services, and when such services are available, they are often quite rudimentary [6, 7].
The Coronavirus disease (COVID)−19 health crisis has highlighted significant deficiencies in emergency services, critical care, and surgical care, resulting in considerable avoidable mortality and morbidity on a global scale. In March 2020, the DRC faced the dual challenges of the COVID-19 pandemic and an Ebola outbreak. These concurrent crises exposed a stark lack of essential resources within healthcare facilities, particularly regarding equipment necessary for intensive care [4, 8].
In addition to these health crises, the DRC, particularly the North Kivu province, has faced significant health challenges due to armed conflicts, natural disasters, and limited healthcare infrastructure [9, 10].
Statistical data indicate that at least 4.2 million individuals die each year within 30 days following a surgical procedure globally, with half of these fatalities occurring in low- or middle-income countries [11]. In numerous circumstances, patients, their relatives, and even healthcare professionals frequently place significant emphasis on the technical aspects of a surgical procedure. However, it is essential to highlight that establishing an optimal perioperative practice is equally critical as the specific technical issues encountered in the surgical field during the execution of the surgical intervention [12, 13].
There is a lack of data regarding the mortality of surgical patients admitted to intensive care units in the North Kivu, a province of eastern DRC, particularly in Goma, the provincial capital. A study aimed at collecting and analyzing information on the factors associated with the mortality of surgical patients in intensive care could address this gap. Understanding these factors could enhance health service planning, resource allocation, and the development of treatment protocols tailored to local needs.
Materials and methods
Study area and period
This study was conducted at HEAL Africa Hospital, a university hospital located in Goma, the capital of the North Kivu province in the eastern part of the DRC, during the period from January 1, 2021, to June 30, 2023. It is equipped with 260 beds, which include 6 beds designated for the adult and children intensive care unit, neonate requiring intensive care have their separate units in the neonatal department. This is a mixed intensive care unit accommodating patients from all departments requiring intensive care. In terms of essential equipment, there are four functional ventilators in the intensive care unit, along with wall-mounted oxygen, oxygen cylinders, and oxygen concentrators available as needed. Multiparameter monitors are also present and mounted on the walls next to each bed.
Population and sampling
In the context of this research, a comprehensive sampling of all surgical patients admitted to the intensive care unit at HEAL Africa Hospital was conducted. The inclusion criteria encompassed patients of all ages and sex with various general surgical conditions admitted to the intensive care unit during the study period. Conversely, the exclusion criteria consisted of female patients who underwent surgery for gynecological or obstetrical issues, as well as patients whose critical data were missing.
Types of study and data collection and analysis
This is a retrospective cross-sectional study.
Data were obtained from the admission and discharge registry of patients admitted to the ICU, facilitating the inclusion of demographic information such as age, sex, originating department, relevant subspecialty, diagnosis, received treatment, types of operations performed, mechanical ventilation use, length of stay in the ICU, and mortality rates. The primary outcome of this study was to determine the overall mortality rate among surgical patients admitted to the ICU. The secondary outcome was to evaluate factors associated with increased mortality in this population. The ICU registry is under the oversight of the head nurse of the ICU, who serves as the primary authority responsible for ensuring data quality. He ensures that the data captured in the registry is accurate and reliable.
For this study, data were extracted from the ICU registry utilizing a pretested questionnaire. The collected data were directly entered into Microsoft Excel and subsequently analyzed using Statistical Package for Social Sciences (SPSS) 26 [IBM, Armonk, NY] for Windows. Logistic regression was chosen as the outcome variable (ICU mortality) is binary (alive/dead).
Regarding the variables used in the analysis, the dependent variable is ICU mortality, coded as a binary variable (1 = death, 0 = alive).
The independent variables were chosen based on their clinical relevance and availability in the ICU registry. These are categorized as follows:
Demographic factors: Age, sex, originating department.
Clinical and management factors: Diagnosis, subspecialty, need for mechanical ventilation (binary: yes/no), operative management (binary: surgical vs. non-operative), type of surgery.
Operational factors: Length of ICU stay, reason for admission.
In the univariate analysis, each variable was individually tested to assess its association with mortality using univariate logistic regression. Variables with a p-value of < 0.05 in this analysis were then included in a multivariate logistic regression model to adjust for confounding factors.
Results
From January 1, 2021, to June 30, 2023, a total of 807 critically ill patients were admitted to the mixed intensive care unit at HEAL Africa Hospital. Of these, 368 patients (43.12%) were surgical cases, originating from the operating room, emergency department, and general hospitalization. However, 20 patients were excluded from the analysis due to missing data. Among the 348 participants included in this study, 74 individuals (21.26%) had succumbed to their conditions.
Demographic characteristics and mortality
The majority of patients admitted to intensive care were male, comprising 217 individuals (62.4%), resulting in a male-to-female ratio of 1.6:1. The median age of the participants was 31 years, with an interquartile range of 20 to 46 years. Ages among the patients varied from 1 year to 85 years. A significant proportion of patients (69.3%) were admitted from the operating room (see Table 1).
Table 1.
Demographic characteristics of patients and mortality rates
| Total n (%) |
Died n (%) |
Survived n (%) |
OR (95% CI) |
p-value | ||
|---|---|---|---|---|---|---|
| Variables | Total | 348 (100) | 74 (21.3) | 274 (78.7) | - | - |
| Sex | ||||||
| Female | 131 (37.6) | 17 (13.0) | 114 (87.0) | - | - | |
| Male | 217 (62.3) | 57 (26.3) | 160 (73.7) | 2.4 (1.3–4.3) | 0.004 | |
| Age | ||||||
| Mean (SD) | 33 (20–46) | 35 (23–47) | 31 (18–45) | - | 0.07 | |
| Originating department | ||||||
| Operating room | 241 (69.2) | 28 (11.6) | 213 (88.4) | 1,0 | - | |
| Emergency room | 94 (27.0) | 41 (43.6) | 53 (56.4) | 5.8 (3.2–11) | < 0.001 | |
| Hospitalization | 13 (3.7) | 5 (38.5) | 8 (61.5) | 4.7 (1.1–18) | 0.02 | |
SD Standard deviation, CI confidence interval, OR Odds Ratio
A statistically significant association was noted between patient sex and mortality, with males exhibiting a higher risk of death in the intensive care unit compared to females (odds ratio (OR): 2.4, 95% confidence interval (CI): 1.3–4.3, p = 0.004). Additionally, a statistically significant relationship was observed between the source of patient admission and mortality. Patients admitted from the emergency department (p < 0.0001) and those from inpatient wards (p = 0.02) had a higher OR of mortality in the ICU compared to those admitted from the operating room (see Table 1).
Clinical features and mortality rates
A significant proportion of patients (54.6%) were sourced from the general surgery subspecialty. The predominant cause for admission to the ICU was postoperative monitoring, which was noted in 57.2% of patients (see Table 2).
Table 2.
Clinical characteristics and mortality
| Total n (%) |
Died n (%) |
Survived n (%) |
OR (95% CI) |
p-value | ||
|---|---|---|---|---|---|---|
| Variables | Total | 348 (100) | 74 (21.3) | 274(78.7) | - | - |
| Diagnostic | < 0.001 | |||||
| Others | 5 (1.4) | 0 (0.0) | 5 (100) | 1.0 (0.000-.) | 1 | |
| Cleft lip and palate | 8 (2.3) | 0 (0.0) | 8 (100) | 1.0 (0.000-.) | 1 | |
| Low limb gangrene | 7 (2.0) | 2 (28.6) | 5 (71.4) | 1.899E-8 (3.557E-9-1.014E-7) | < 0.001 | |
| GI bleeding | 3 (0.9) | 3 (100) | 0 (0.0) | 2.725E-17 (0.000-.) | 0.997 | |
| Pancreatitis | 6 (1.7) | 2 (33.3) | 4 (66.7) | 1.519E-8(2.690E-9-8.584E-8) | < 0.001 | |
| Bowel obstruction | 19 (5.5) | 2 (10.5) | 17 (89.5) | 6.458E-8 (1.434E-8-2.908E-7) | < 0.001 | |
| Colorectal conditions | 12 (3.4) | 0 (0.0) | 12 (100) | 1.0 (0.000-.) | < 0.001 | |
| Brain abscess | 5 (1.4) | 2 (40.0) | 3 (60.0) | 1.140E-8 (1.843E-9-7.045E-8) | < 0.001 | |
| Skin and subcutaneous conditions | 11 (3.2) | 0 (0.0) | 11 (100) | 1.0 (0.000-.) | 1 | |
| Upper airways obstruction | 9 (2.6) | 2 (22.2) | 7 (77.8) | 2.659E-8 (5.324E-9-1.328E-7) | < 0.001 | |
| Gastroduodenal ulcer | 8 (2.3) | 3 (37.5) | 5 62.5 | 1.266E-8 (2.906E-9-5.517E-8) | < 0.001 | |
| Non-traumatic Orthopedic conditions | 16 (4.6) | 1 (6.3) | 15 (93.7) | 1.140E-7 (1.463E-8-8.879E-7) | < 0.001 | |
| Goiter | 6 (1.7) | 0 (0.0) | 6 (100) | 1.0 (0.000-.) | 1 | |
| Peritonitis | 55 (15.8) | 11 (20.0) | 44 (80.0) | 3.039E-8 (1.444E-8-6.396E-8) | < 0.001 | |
| Trauma | 160 (46.0) | 46 (28.7) | 114 (71.3) | 1.883E-8 (1.883E-8-1.883E-8) | - | |
| Iatrogenic ureteric injury | 18 (5.2) | 0 (0.0) | 18 (100) | 1.0 | - | |
| Subspeciality | < 0.0001 | |||||
| General surgery | 190 (54.6) | 42 (30) | 148 (70) | 1.0 | - | |
| Neurosurgery | 79 (22.7) | 28 (35) | 51 (65) | 1.9 (1.0–3.6) | 0.03 | |
| Orthopedics | 52 (14.9) | 4 (7.7) | 48 (92.3) | 0.3(0.1–0.9) | 0.02 | |
| Urology | 18 (5.2) | 0 (0.0) | 18 (100) | - | 0.03 | |
| Plastic surgery | 9 (2.6) | 0 (0.0) | 9 (100) | - | 0.02 | |
| Length of stay | ||||||
| Median (IQR) | 2 (1–4) | 2 (1–5) | 2 (1–4) | - | 0.06 | |
| Reason of admission | < 0.0001 | |||||
| Post op monitoring | 199(57.2) | 16 (8.0) | 183 (92.0) | 1.0 | - | |
| Polytrauma | 80 (23.0) | 31 (38.7) | 49 (61.3) | 7.2(3.5–15) | < 0.0001 | |
| Severe sepsis | 44 (12.6) | 13 (29.6) | 31(70.4) | 4.8 (1.9–12) | 0.0003 | |
| Respiratory distress | 21 (6.0) | 10 (47.6) | 11 (52.4) | 10 (3.3–31) | < 0.0001 | |
| Hemorrhagic shock | 4 (1.2) | 0 (0.0) | 4 (100) | - | > 0.99 |
GI Gastrointestinal, IQR Interquartile range, CI Confidence interval, OR Odds Ratio
A statistically significant relationship is identified between the admission diagnosis (p < 0.0001), surgical subspecialty (p < 0.0001), the reason for intensive care admission (p < 0.0001), and mortality outcomes (see Table 2).
Therapeutic factors and mortality
A significant proportion of patients admitted to the ICU had undergone surgical procedures, accounting for 80.7% of the total population, while 19.3% received non-operative treatment. Notably, all patients diagnosed with gastrointestinal bleeding (100%) underwent non-operative treatment. Similarly, 40% of patients with brain abscess and 34% of those with trauma received non-operative management. Certain conditions, such as cleft lip and palate, goiter, lower limb gangrene, and skin and subcutaneous conditions, were exclusively managed surgically. The majority of patients (83.3%) did not require mechanical ventilation. In total, 58 patients required mechanical ventilation, representing 16.7% of the overall population. Conditions associated with the highest ventilation needs included trauma (25%), peritonitis (16.4%), and upper airways obstruction (22.2%) (see Table 3).
Table 3.
Diagnostic and management
| Type of management | Mechanical ventilation | ||||
|---|---|---|---|---|---|
| Diagnostic |
Total n(%) |
Surgical n(%) |
Non-operative n(%) |
No n(%) |
Yes n(%) |
| Others | 5 (1.4) | 5 (100) | 0 (0) | 5 (100) | 0 (0) |
| Cleft lip and palate | 8 (2.3) | 8 (100) | 0 (0) | 8 (100) | 0 (0) |
| Low limb gangrene | 7 (2.0) | 7 (100) | 0 (0) | 7 (100) | 0 (0) |
| GI bleeding | 3 (0.9) | 0 (0) | 3 (100) | 2 (66.7) | 1 (33.3) |
| Pancreatitis | 6 (1.7) | 5 (83.3) | 1 (16.7) | 5 (83.3) | 1 (16.7) |
| Bowel obstruction | 19 (5.5) | 18 (94.7) | 1 (5.3) | 18 (94.7) | 1 (5.3) |
| Colorectal conditions | 12 (3.4) | 11 (91.7) | 1 (8.3) | 11 (91.7) | 1 (8.3) |
| Brain abscess | 5 (1.4) | 3 (60) | 2 (40) | 4 (80) | 1 (20) |
| Skin and subcutaneous conditions | 11 (3.2) | 11 (100) | 0 (0) | 11 (100) | 0 (0) |
| Upper airways obstruction | 9 (2.6) | 9 (100) | 0 (0) | 7 (77.8) | 2 (22.2) |
| Gastroduodenal ulcer | 8 (2.3) | 6 (75) | 2 (25) | 7 (87.5) | 1 (12.5) |
| Non-traumatic Orthopedic conditions | 16 (4.6) | 16 (100) | 0 (0) | 15 (93.7) | 1 (6.3) |
| Goiter | 6 (1.7) | 6 (100) | 0 (0) | 6 (100) | 0 (0) |
| Peritonitis | 55 (15.8) | 53 (96.4) | 2 (3.6) | 46 (83.6) | 9 (16.4) |
| Trauma | 160 (46.0) | 105 (65.6) | 55 (34.4) | 120 (75) | 40 (25) |
| Iatrogenic ureteric injury | 18 (5.2) | 18 (100) | 0 (0) | 18 (100) | 0 (0) |
| Total | 348 (100) | 281 (80.7) | 67 (19.3) | 290 (83.3) | 58 (16.7) |
GI Gastrointestinal bleeding
The odds of mortality in ICU were found to be 56 times greater for patients who were placed on ventilators (p < 0.0001). Additionally, it was observed that surgical patients who did not undergo any surgical procedures had an OR of 6.2 for mortality in intensive care compared to those who did undergo surgery (p < 0.0001) (see Table 4).
Table 4.
Therapeutic factors and mortality
| Total n (%) |
Died n (%) |
Survived n (%) |
OR (95% CI) |
p-value | ||
|---|---|---|---|---|---|---|
| Variables | Total | 348 (100) | 74 (21.3) | 274 (78.7) | - | - |
| Mechanical ventilation | ||||||
| No | 290 (83.3) | 25 (8.6) | 265 (91.4) | 1.0 | - | |
| Yes | 58 (16.7) | 49 (84.5) | 9 (15.5) | 56 (24–147) | < 0.0001 | |
| Type of management | ||||||
| Surgical | 281(80.7) | 40 (14.2) | 241(85.8) | 1.0 | - | |
| Non-operative | 67 (19.3) | 34 (50.7) | 33 (49.3) | 6.2 (3.3–12) | < 0.0001 | |
OR Odds Ratio, CI Confidence interval
Discussion
This study primarily aimed to identify the factors associated with mortality among patients with surgical conditions admitted to the ICU of HEAL Africa Hospital. More specifically, we sought to determine the demographic, clinical, and therapeutic characteristics linked to the mortality of these patients.
This study revealed a mortality rate of 21.26% among surgical patients admitted to intensive care. This figure is comparable to those observed in Lubumbashi (19.8%), Yemen (20%), and South Africa (22.4%) [14–16]. On the other hand, it is lower than the mortality rates reported by Endeshaw et al. (45%) in Ethiopia, Rad (39.8%) in Ethiopia, Zhang et al. (32.6%) in China, and Ahmed et al. (51%) in Bangladesh [17–20]. The observed difference can be attributed to the specific characteristics of the studied population. Our analysis indicates that a significant proportion of patients admitted to the ICU were actually in a phase of postoperative monitoring. This postoperative observation is influenced not only by the complexity of the surgical procedures undergone by the patients but also by organizational constraints, such as a reduced availability of nursing staff in the recovery room for surgeries conducted later in the day. This practice contrasts with that seen in many other intensive care units, where admissions are more closely associated with the severity of the patients’ illnesses or the complexity of the surgeries performed [21–23].
Demographic characteristics and mortality
Our study indicates a significantly higher mortality rate among men, with a p-value of 0.004. However, numerous previous studies have not demonstrated any significant variation in mortality rates [16, 19, 24, 25]. The observed differences within our study population can be ascribed to the varying pathologies identified in males and females. Males are more frequently affected by polytrauma and neurosurgical conditions. Furthermore, hormonal disparities between male and female individuals may impact the body’s response to severe illness and affect recovery rates. For instance, it is hypothesized that the estrogen present in females exerts positive effects on cardiovascular health and immune response [26].
It has been observed that age does not play a significant role in mortality (p = 0.07). This finding aligns with the results of several other studies that have similarly demonstrated the lack of influence of age on mortality [19, 22, 23, 25]. However, further research has highlighted a high mortality rate among older individuals. Indeed, the literature links an age greater than 65 years to various comorbidities, including cardiovascular, pulmonary, metabolic, and neurological diseases. Additionally, their immune system may be compromised, resulting in a less effective inflammatory response during stressful situations such as surgery. This stress increases the risk of severe complications and mortality [27, 28]. Our findings can be attributed to the demographic composition of our study population, which predominantly consisted of younger individuals. The age distribution within the Congolese population reveals that approximately 55.7% of individuals are 19 years old or younger, 41.2% fall within the age range of 20 to 64 years, and merely 3.1% are aged 65 years or older [29].
In the course of this research, it was noted that the majority of surgical patients admitted to the ICU originated from the operating room. Patients arriving from the emergency department exhibited a significantly higher risk of mortality compared to those coming from inpatient wards or the operating room (p < 0.0001). These findings contrast with those reported by other authors, who observed that most patients admitted to ICU were sourced from emergency services [23, 30, 31]. In addition to the previously mentioned reasons, it is crucial to emphasize that patients arriving from emergency services who require surgical intervention are primarily directed to the operating room. This categorizes them more as operating room patients rather than emergency patients. Consequently, this practice diminishes the number of admissions from emergency services for our study.
Clinical characteristics and mortality
The findings of this study suggest that patients within the field of neurosurgery exhibit a higher mortality rate compared to those from other specialties. This observation aligns with the results of a previous study conducted in Ethiopia [32]. This situation can be attributed to the fact that the majority of our patients admitted for neurosurgical conditions experience severe head trauma, which are linked to a high risk of mortality in intensive care, as highlighted by several authors [17, 30, 33, 34].
The primary reason for admission to ICU was postoperative monitoring, a finding that aligns with the results of Endeshaw et al. in Ethiopia, who also noted this trend [17]. Numerous other authors have recognized various diagnostic categories as reasons for admission [23, 31, 35]. There is also no association whatsoever between mortality and the reason for admission to the intensive care unit [23]. This situation can be attributed to the disparities in the studied population and the criteria for admission to ICU, which differ from one institution to another. For instance, in our study, the lack of a nurse for the postoperative monitoring of patients who underwent surgery late in the day may lead to the admission of a patient to the ICU without any other justification for such admission.
The findings of this study indicated that there was no statistically significant impact of the length of stay in the ICU on mortality rates. These conclusions contradict the results reported by other researchers who found a significant relationship between length of stay and mortality [23, 25]. According to these authors, an extended stay is a factor that increases mortality in ICU. In our study, the lack of a significant impact of length of stay on mortality may be attributed to the average short duration of 2 days that our patients spent in intensive care. This is further elucidated by the observation that most of our patients were admitted for postoperative monitoring.
Therapeutic factors and mortality
In this study, surgical patients who did not undergo an operation exhibited a higher risk of death. Although the ICU registry does not document the reasons for these patients’ lack of surgery, existing literature sheds light on this issue. For instance, a study focusing on older patients found that those who were not operated on had an increased mortality risk, particularly when the surgeon deemed the procedure too risky compared to its potential benefits [36]. Additionally, Ahmed et al. reported a preference for traditional healers over modern treatments in northern Sudan [37]. Financial constraints further complicate access to surgical care; in many low- and middle-income countries, patients often bear healthcare costs out of pocket, which can limit their ability to obtain necessary surgeries [38]. Moreover, the unavailability of qualified surgeons to perform specific procedures may contribute to the lack of surgical intervention, thereby increasing the mortality rates among these patients [39, 40]. These factors contributing to the non-operability of surgical patients in other settings may not be directly applicable to our population, highlighting the need for context-specific analysis and consideration of local healthcare dynamics.
It has been observed that patients requiring mechanical ventilation exhibited a significantly higher risk of mortality, specifically 56 times greater, in ICU compared to those who did not undergo mechanical ventilation. Additional studies have also indicated an increased risk of death in the intensive care setting for patients who were mechanically ventilated [18, 23, 30, 41, 42]. The underlying condition that required the patient to be placed on mechanical ventilation, along with the severity of that condition and the presence of comorbidities, has been identified as key factors contributing to the increased mortality rate [43, 44].
Limitations
This study, while providing valuable insights into the factors associated with mortality among surgical ICU patients in North Kivu, DRC, has several limitations that should be considered:
Retrospective Design and Missing Data: The retrospective nature, combined with the absence of computerized patient tracking at the hospital, poses a risk of missing data. Notably, comorbidities, known to significantly impact ICU mortality, were not assessed due to their absence in the ICU registry. Additionally, laboratory values were not available, which could have provided crucial information on patient severity and outcomes.
Lack of Traditional Scoring Systems: Unlike other studies, traditional scoring systems such as APACHE II and SOFA were not utilized. This omission is due to the lack of necessary clinical data required for calculating these scores. The absence of these standardized tools limits the study’s ability to compare outcomes with other ICUs globally.
Insufficient Detail on Non-Operative Management and mechanical ventilation: The registry did not document the reasons why certain patients requiring surgery did not undergo operative intervention. Additionally, details regarding the specific non-operative management strategies employed were not recorded, making it difficult to fully assess the context of care decisions. Similarly, information on mechanical ventilation, including the rationale for its use, availability when needed, and duration of ventilation, was not systematically captured.
No External Validation Cohort: this reduces the generalizability of the findings to other settings. This limitation underscores the need for future studies to validate these results in different contexts.
Pioneering Study in the Region: Despite its limitations, this study represents the first regional analysis of surgical patients in intensive care units (ICUs), serving as a crucial foundation for future research. Prospective studies should aim to expand upon these findings by systematically collecting comprehensive data, including missing parameters such as comorbidities and detailed management strategies. Addressing these gaps will enhance the reliability and applicability of outcomes. Additionally, further investigation into the factors influencing mortality among non-operative patients with surgical conditions is strongly recommended to refine clinical decision-making and improve patient outcomes.
Conclusion
This study reveals critical insights into surgical ICU mortality in North Kivu, Democratic Republic of the Congo, where 21.3% of surgical ICU patients died, with mechanical ventilation and non-operative management emerging as key factors. These findings underscore the urgent need for context-specific interventions in low-resource settings and align with global surgery priorities to reduce disparities in surgical outcomes.
Acknowledgements
Not applicable.
Abbreviations
- CI
Confidence Interval
- COVID
Corona Virus disease
- DRC
Democratic Republic of the Congo
- ICU
Intensive Care Unit
- IQR
Interquartile Range
- OR
Odds Ratio
- SD
Standard Deviation
- SPSS
Statistical Package for Social Sciences
Authors’ contributions
JFB designed the study, while KMP and JFB handled data collection and statistical analysis. JFB wrote the main manuscript text, and KMC and KMJP supervised the study. All authors reviewed the manuscript.
Funding
No funding was received for this research.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
We have ensured adherence to the principles outlined in the Declaration of Helsinki [45]. The research protocol was submitted to the ethics committee of the University of Goma, to ensure compliance with ethical standards (Approval Number: UNIGOM/CEM/003/2024). Since this was a retrospective data analysis that did not involve direct contact with participants, informed consent was not obtained.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
No datasets were generated or analysed during the current study.