Why the study?
Open surgical repair remains the only option for aortic aneurysms in low-resource settings like Ethiopia, but patient characteristics, perioperative management, and outcomes were unexamined.
Open surgical repair of aortic aneurysms in a low-resource setting is feasible but associated with significant in-hospital mortality (13.3%) and major complications, which are exacerbated by prolonged cross-clamp times and resource constraints.
OSR for aortic aneurysms in low-resource settings shows 13% mortality with frequent complications; leaves open optimal patient selection and perioperative strategies for similar cohorts.
Background Aortic aneurysms (AAs) are life-threatening conditions requiring timely surgical intervention. While endovascular repair is most common in high-income countries, open surgical repair (OSR) remains the only option in low-resource settings like Ethiopia. This study aimed to examine patient characteristics, perioperative management, and outcomes of OSR at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. Methods We conducted a retrospective observational study of adult patients who underwent OSR between January 2017 and May 2024. Data were extracted from the operating room (OR) logbook and surgical intensive care unit (SICU) registry using a structured tool. Descriptive statistics summarized patient characteristics and perioperative care, while logistic regression analyses identified predictors of in-hospital mortality and major complications. Statistical significance was set at p < 0.05. Results A total of 45 patients (mean age 54.4 ± 16.3 years; 57.8% female) were included in the study. Most had abdominal aneurysms (88.9%) and underwent elective surgery. In-hospital mortality was 13.3%, and 37.8% experienced major complications, excluding deaths. Acute kidney injury (AKI, 22.2%) and hospital-acquired pneumonia (15.8%) were the most common. Ischemic heart disease (IHD) was notably associated with increased risk of mortality (crude odds ratio (COR) = 9.25; p = 0.080), AKI (COR = 14.57; p = 0.030), and respiratory complications (COR = 27.75; p = 0.009). A cross-clamp time exceeding 90 minutes was significantly associated with increased mortality (COR = 7.75; p = 0.035) and AKI (COR = 7.25; p = 0.013). Elevated baseline serum creatinine (≥1 mg/dL) was also significantly associated with the development of AKI (COR = 22.67; p = 0.006). Conclusion This study highlights the feasibility and challenges of open AA repair in resource-limited Ethiopia. Despite a few cases, younger, low-comorbidity patients reflect selective surgery due to constraints. Shortages in equipment, medications, and ICU beds significantly hindered perioperative monitoring, anesthesia care, and pain management, impacting overall surgical outcomes.
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Shiferaw et al. (2025) studied this question.
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