{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T18:00:25Z","timestamp":1785348025970,"version":"3.55.0"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Safe surgery is a fundamental quality indicator within the global surgery framework. Postoperative complications remain a leading global cause of disability, mortality, and economic loss, with a disproportionate impact on low- and middle-income countries (LMICs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to generate robust epidemiological data on postoperative outcomes of cancer surgery in Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study employed a 7-day national observational prospective cohort design. The study enrolled adult patients aged 18 years and older who underwent either elective or non-elective cancer surgery in hospitals across Ethiopia. Statistical analysis included descriptive statistics, chi-square tests for categorical variables, and logistic regression models to identify risk factors for postoperative complications. Outcome measures 7\n                      <jats:sup>th<\/jats:sup>\n                      day postoperative mortality and complications. Statistical significance was set at p\u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 265 cancer surgeries were performed across 46 hospitals (overall surgeries\u2009=\u20094412). The mean patient age was 46.6 years (SD\u2009=\u200914.9). The majority of patients were classified as low-risk America Society of Anesthesiologists (ASA) physical status classification: ASA I (106\/265, 40%) and ASA II (133\/265, 50.2%) and low Eastern Cooperative Oncology Group (ECOG) performance status: ECOG 0 (112\/265, 42.3%) and ECOG 1 (98\/265, 37%). Colorectal cancer surgery was the most common type (38\/265, 14.5%), while laparoscopic surgery was performed in only 3\/265 cases (1.1%). Postoperative complications developed in 84 of 265 patients (31.7%) with leading complication was superficial surgical site infection 47\/265(17.8%). Emergency surgery (AOR\u2009=\u20093.1, 95% CI: 1.1\u20138.4, p\u2009=\u20090.003), comorbidity (AOR\u2009=\u20092.0, 95% CI: 1.1\u20133.7, p\u2009=\u20090.025), and an ECOG performance status of III (AOR\u2009=\u20099.5, 95% CI: 1.5\u201361.1, p\u2009=\u20090.02) were statistically significantly associated with 7\n                      <jats:sup>th<\/jats:sup>\n                      day postoperative complications. The overall 7-day mortality rate after cancer surgery was 5\/265 (1.9%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite the relatively young age of patients, their low ASA physical status scores, and good ECOG performance, a significant proportion experienced adverse outcomes following cancer surgery: one in three patients developed postoperative complications, one in nine required reoperations, and one in 53 died. These findings suggest a critical need for evidence-based interventions to strengthen the underlying infrastructure and care processes within the surgical system which are essential to achieving safe, effective, and high-quality surgical care for cancer patients in Ethiopia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354980","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:27:18Z","timestamp":1785346038000},"page":"e0354980","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cancer surgical outcome study in Ethiopia: A 7-day multicenter prospective observational cohort study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8611-599X","authenticated-orcid":true,"given":"Atalel Fentahun","family":"Awedew","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonatan Abie","family":"Tsegaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Addisu Assfaw","family":"Ayen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fisiha Guade","family":"Tesifaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bedemariam Tadesse","family":"Amsalu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amsalu Molla","family":"Getahun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"issue":"3","key":"pone.0354980.ref001","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"F Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"pone.0354980.ref002","volume-title":"World Cancer Report: Cancer Research for Cancer Prevention","author":"CP Wild","year":"2020"},{"issue":"16","key":"pone.0354980.ref003","doi-asserted-by":"crossref","first-page":"3029","DOI":"10.1002\/cncr.33587","article-title":"The ever-increasing importance of cancer as a leading cause of premature death worldwide","volume":"127","author":"F Bray","year":"2021","journal-title":"Cancer"},{"issue":"10","key":"pone.0354980.ref004","doi-asserted-by":"crossref","DOI":"10.1016\/S1470-2045(18)30681-8","article-title":"National cancer control plans: a global analysis","volume":"19","author":"Y Romero","year":"2018","journal-title":"Lancet 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Perera","year":"2021","journal-title":"Lancet Oncol"},{"issue":"6","key":"pone.0354980.ref008","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(15)70115-4","article-title":"Global access to surgical care: a modelling study","volume":"3","author":"BC Alkire","year":"2015","journal-title":"Lancet Glob Health"},{"issue":"4","key":"pone.0354980.ref009","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s00268-008-9525-9","article-title":"Surgery and global health: a view from beyond the OR","volume":"32","author":"PE Farmer","year":"2008","journal-title":"World J Surg"},{"issue":"12","key":"pone.0354980.ref010","doi-asserted-by":"crossref","first-page":"3038","DOI":"10.1007\/s00268-017-4271-5","article-title":"Safe Surgery for All: Early Lessons from Implementing a National Government-Driven Surgical Plan in Ethiopia","volume":"41","author":"D Burssa","year":"2017","journal-title":"World J 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82 countries","volume":"397","author":"Groups GlobalSurg Collaborative","year":"2021","journal-title":"Lancet"},{"issue":"3","key":"pone.0354980.ref014","doi-asserted-by":"crossref","DOI":"10.1097\/AS9.0000000000000480","article-title":"Towards establishing a national perioperative quality improvement network in LMICs: Implementation experiences from Ethiopia","volume":"5","author":"F Kifle","year":"2024","journal-title":"Ann Surg Open"},{"issue":"5","key":"pone.0354980.ref015","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.jamcollsurg.2009.07.003","article-title":"Variability in reoperation rates at 182 hospitals: a potential target for quality improvement","volume":"209","author":"RP Merkow","year":"2009","journal-title":"J Am Coll Surg"},{"key":"pone.0354980.ref016","volume-title":"National Surgical Care Strategic Plan: Saving Lives Through Safe Surgery II (SaLTS II, 2021\u20135)","author":"Ministry of Health, Health Service Quality Directorate (HSQD)(Ethiopia)","year":"2021"},{"issue":"11","key":"pone.0354980.ref017","article-title":"High-quality health systems in the Sustainable Development Goals era: time for a revolution","volume":"6","author":"ME Kruk","year":"2018","journal-title":"Lancet Glob Health"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354980","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:27:22Z","timestamp":1785346042000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354980"}},"subtitle":[],"editor":[{"given":"Abraham Tamirat","family":"Gizaw","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":17,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0354980","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]}}}