Perioperative outcomes of abdominal surgery in Ethiopia: a national clinical audit (2019–2024)

Perioperative complications remain a significant global concern, contributing substantially to disability, mortality, and economic loss, particularly in low- and middle-income countries (LMICs). This study utilized data from the National Perioperative Quality Improvement Network (NaPQIN) perioperative registry database in Ethiopia. We extracted data from 3226 abdominal surgical patients recorded in the NaPQIN perioperative registry database in Ethiopia. The median patient age was 34 years (Inter quartile range (IQR): 26-45 years), with a majority (55.8%, n = 1797) being male and classified American Society of Anesthesiologists (ASA) class I-II. The overall postoperative complication rate was 9.0% (290/3226), and the 30-day mortality rate was 1.50% (48/3226). The World Health Organization (WHO) Surgical Safety Checklist was utilized in 91.49% of procedures (2935/3226). Multivariable analysis identified significant associations between postoperative complications and both hypertension (adjusted odd ratio (AOR) = 2.61, 95% CI: 1.53-4.46, p < 0.001) and cancer (AOR = 2.53, 95% CI: 1.45-4.40, p = 0.001). Our findings indicate that approximately one in eleven patients undergoing abdominal surgery experiences a postoperative complication, and one in sixty-six dies before discharge. These results highlight the pressing need for evidence-based interventions to strengthen the foundation, care processes, and overall quality of the surgical system in Ethiopia.