{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:19:16Z","timestamp":1790738356986,"version":"4.1.0"},"reference-count":26,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Center for Health Equity in Surgery and Anesthesia at the University of California, San Francisco","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,5]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the outcomes of patients undergoing open abdominal surgery at a National Referral Hospital in Tanzania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A prospective, observational, single-arm cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Dar es Salaam, Tanzania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients who underwent open abdominal surgery between August 2022 and July 2023 were included. Patients were enrolled if they provided informed consent to participate and were \u226518 years of age. Patients were excluded if they were lost to follow-up, were admitted outside the department of surgery or were still admitted since the index surgery at the end of the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was a composite measurement of mortality that includes patients who died during the index admission and those who died up to 30 days postdischarge. Secondary outcomes included surgical complications, unplanned readmissions, economic burden and functional outcomes. Clinically relevant factors identified a priori and with a p value of \u22640.2 in the univariable model were tested in a multivariable logistic regression to identify independent risk factors for composite mortality, with backward stepwise elimination using a statistical significance set at a p value &lt;0.05\u2009and 95%\u2009CI not including 1.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 626 patients who had an open abdominal surgery, 555 (88.7%) met the inclusion criteria, of which 120 (21.6%) died. Of the deaths, 61 (51%) occurred during the index admission, 48 (40%) outside the hospital and 11 (9%) following unplanned readmission. Among the surviving 435 (78%) patients who participated in the 30-day follow-up, those without insurance were less likely to return to work (7.3% vs 16% insured) and had higher out-of-pocket expenses ($321 vs $82 insured).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Open abdominal surgery carries a composite mortality rate of 22% with almost half of deaths occurring after index hospital discharge. These findings underscore the need for routine follow-up, early complication identification and management and universal health coverage to improve outcomes, and reduce financial hardships.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107672","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T13:33:40Z","timestamp":1782740020000},"page":"e107672","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of open abdominal surgery at a single-centre tertiary referral hospital in Tanzania: a prospective, observational, single-arm cohort study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0405-3364","authenticated-orcid":false,"given":"Nathan","family":"Brand","sequence":"first","affiliation":[{"name":"Department of Surgery, University of California San Francisco, San Francisco, California, USA"},{"name":"Department of Surgery, University of New Mexico, Albuquerque, NM, USA"},{"name":"Center for Health Equity in Surgery and Anesthesia, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry","family":"Akoko","sequence":"additional","affiliation":[{"name":"Center for Health Equity in Surgery and Anesthesia, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA"},{"name":"Department of Surgery, Muhimbili University for Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Obedi","sequence":"additional","affiliation":[{"name":"Center for Health Equity in Surgery and Anesthesia, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA"},{"name":"Department of Surgery, Muhimbili University for Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ally","family":"Mwanga","sequence":"additional","affiliation":[{"name":"Center for Health Equity in Surgery and Anesthesia, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA"},{"name":"Department of Surgery, Muhimbili University for Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey Sama","family":"Philipo","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of"},{"name":"The Branch for Global Surgical Care, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Komba","sequence":"additional","affiliation":[{"name":"Department of Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa","family":"Boeck","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Francisco, San Francisco, California, USA"},{"name":"Center for Health Equity in Surgery and Anesthesia, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"2026062906301494000_16.6.e107672.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-015-3153-y"},{"key":"2026062906301494000_16.6.e107672.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2018-001282","article-title":"Towards equitable surgical systems: development and outcomes of a national surgical, obstetric and anaesthesia plan in Tanzania","volume":"4","author":"Citron","year":"2019","journal-title":"BMJ Glob Health"},{"key":"2026062906301494000_16.6.e107672.3","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2020.e04295","article-title":"Patient\u2019s characteristics, management practices and outcome of re-laparotomies in a tertiary hospital in Tanzania","volume":"6","author":"Swallow","year":"2020","journal-title":"Heliyon"},{"key":"2026062906301494000_16.6.e107672.4","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s00268-020-05802-w","article-title":"In-Hospital Postoperative Mortality Rates for Selected Procedures in Tanzania\u2019s Lake Zone","volume":"45","author":"Wurdeman","year":"2021","journal-title":"World J Surg"},{"key":"2026062906301494000_16.6.e107672.5","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1111\/rode.12829","article-title":"Understanding poverty dynamics and vulnerability in Tanzania: 2012\u20132018","volume":"25","author":"Aikaeli","year":"2021","journal-title":"Review Development Economics"},{"key":"2026062906301494000_16.6.e107672.6","doi-asserted-by":"crossref","DOI":"10.5334\/aogh.1355","article-title":"The Economic Burden of Non-fatal Musculoskeletal Injuries in Northeastern Tanzania","volume":"85","author":"Davey","year":"2019","journal-title":"Ann Glob Health"},{"key":"2026062906301494000_16.6.e107672.7","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-017-4368-x"},{"key":"2026062906301494000_16.6.e107672.8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0201833","article-title":"Understanding variations in health insurance coverage in Ghana, Kenya, Nigeria, and Tanzania: Evidence from demographic and health surveys","volume":"13","author":"Amu","year":"2018","journal-title":"PLoS ONE"},{"key":"2026062906301494000_16.6.e107672.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-063297","article-title":"Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study","volume":"13","author":"Gulamhussein","year":"2023","journal-title":"BMJ Open"},{"key":"2026062906301494000_16.6.e107672.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.0040296","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"4","author":"von Elm","year":"2007","journal-title":"PLoS Med"},{"key":"2026062906301494000_16.6.e107672.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12962-023-00457-5","article-title":"Overview of the main methods used for estimating catastrophic health expenditure","volume":"21","author":"Nguyen","year":"2023","journal-title":"Cost Eff Resour Alloc"},{"key":"2026062906301494000_16.6.e107672.12","doi-asserted-by":"crossref","unstructured":"Harris PA , Taylor R , Minor BL , et al . The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019;95. doi:10.1016\/j.jbi.2019.103208","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"2026062906301494000_16.6.e107672.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2026062906301494000_16.6.e107672.14","doi-asserted-by":"crossref","DOI":"10.1186\/1751-0473-3-17","article-title":"Purposeful selection of variables in logistic regression","volume":"3","author":"Bursac","year":"2008","journal-title":"Source Code Biol Med"},{"key":"2026062906301494000_16.6.e107672.15","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2025.53228","article-title":"Social Determinants of Health and 30-Day Mortality After Inpatient Elective Surgery","volume":"9","author":"Sankar","year":"2026","journal-title":"JAMA Netw Open"},{"key":"2026062906301494000_16.6.e107672.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(96)00236-3"},{"key":"2026062906301494000_16.6.e107672.17","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwk052"},{"key":"2026062906301494000_16.6.e107672.18","doi-asserted-by":"crossref","DOI":"10.1186\/s12893-022-01883-7","article-title":"Surgical Apgar score as a predictor of outcomes in patients following laparotomy at Mulago National Referral Hospital, Uganda: a prospective cohort study","volume":"22","author":"Onen","year":"2022","journal-title":"BMC Surg"},{"key":"2026062906301494000_16.6.e107672.19","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00223-5"},{"key":"2026062906301494000_16.6.e107672.20","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s00268-019-05234-1","article-title":"Curative Surgery Improves Survival for Colorectal Cancer in Rural Kenya","volume":"44","author":"Parker","year":"2020","journal-title":"World J Surg"},{"key":"2026062906301494000_16.6.e107672.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30001-1"},{"key":"2026062906301494000_16.6.e107672.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12893-024-02319-0","article-title":"Prevalence and mortality rate of abdominal surgical emergencies in Sub-Saharan Africa: a systematic review and meta-analysis","volume":"24","author":"Ndong","year":"2024","journal-title":"BMC Surg"},{"key":"2026062906301494000_16.6.e107672.23","doi-asserted-by":"crossref","DOI":"10.1186\/s13017-020-0288-4","article-title":"Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines","volume":"15","author":"De Simone","year":"2020","journal-title":"World J Emerg Surg"},{"key":"2026062906301494000_16.6.e107672.24","doi-asserted-by":"crossref","first-page":"e1391","DOI":"10.1016\/S2214-109X(21)00291-6","article-title":"Enhanced postoperative surveillance versus standard of care to reduce mortality among adult surgical patients in Africa (ASOS-2): a cluster-randomised controlled trial","volume":"9","author":"Biccard","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2026062906301494000_16.6.e107672.25","doi-asserted-by":"crossref","DOI":"10.3402\/gha.v7.23137","article-title":"The association between insurance status and in-hospital mortality on the public medical wards of a Kenyan referral hospital","volume":"7","author":"Stone","year":"2014","journal-title":"Glob Health Action"},{"key":"2026062906301494000_16.6.e107672.26","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/S0140-6736(24)00133-8","article-title":"Financing Tanzania\u2019s universal health insurance","volume":"403","author":"Buguzi","year":"2024","journal-title":"The Lancet"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-107672","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T13:33:51Z","timestamp":1782740031000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-107672"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,29]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bmjopen-2025-107672"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107672","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}