Background 


The non-cardiac surgical population represents a major global public health burden with approximately 234 million major surgical procedures performed worldwide each year. In unselected non-cardiac surgical patients, reports of early postoperative mortality vary between 2 and 4%, with an annual global mortality of 5 to 10 million. Surgery is a cost-effective intervention, even in low to middle income countries and as such it is considered a core component of health. The Lancet Commission on Global Surgery was established to define safe surgery and develop strategies to ensure the adequate provision of safe surgery.

Recently, the African Surgical Outcomes Study (ASOS) demonstrated, that despite a patient low risk profile and low complication rates, patients in Africa were twice as likely to die following surgery when compared to the global average. ASOS provides the most comprehensive data on surgical outcomes in Africa, comprising 25 countries, 247 hospitals, and data from over 11 000 patients. Importantly, 95% of the deaths in ASOS occurred in the postoperative period, suggesting that many lives could be saved by effective surveillance for physiological deterioration amongst the patients who developed complications.

It is likely that a major contributor to the high mortality in ASOS was ‘failure to rescue’ partly due to an inadequacy of sufficient human resources necessary to identify postoperative surgical patients at risk. The solution to improving surgical outcomes in Africa is identification of the high-risk surgical patient prior to further physiological deterioration.

Study Design


ASOS-2 is an international African, multicentre, cluster randomised trial. The primary outcome is in-hospital mortality, censored at 30 days if the patient is still alive and in-hospital.

The intention is to provide a pragmatic solution to decreasing postoperative morbidity and mortality across Africa. This trial will run across at least 25 African countries in early 2019.

Prepatory Work


This study is built on the successful collaboration of the African Surgical Outcomes Study (ASOS) which ran across 25 African countries in 2016, recruiting nearly 11 500 patients, and including over 1000 African clinician investigators. The intervention is based on the signal from ASOS of the major driver for postoperative morbidity and mortality in Africa. This will be the first continental collaborative trial of surgical outcomes in Africa.

Importance of this Study


Africa has a population of 1.2 billion people, yet 95% of these people do not have access to safe surgery. Surgery in Africa is currently associated with significant morbidity secondary to ‘failure to rescue’ in the postoperative period. It is hoped that this trial will make a significant contribution to improving the safety of surgery in Africa. The trial design is sufficiently pragmatic to ensure that it the findings are implementable across Africa.

FAQs


For a list of frequently asked questions please click here

Newsletters


To read the ASOS-2 newsletters, please click here

Click below to download the study documents

Study Protocol

English

ASOS-2 protocol

French

ASOS-2 protocol

Portuguese

ASOS-2 protocol

Tanzania

ASOS-2 protocol

Outcomes Definitions

English

ASOS-2 Definitions Document

French

ASOS-2 Definitions Document

Portuguese

ASOS-2 Definitions Document

Broadcasting

English

ASOS-2 Broadcasting

French

ASOS-2 Broadcasting

Portuguese

ASOS-2 Broadcasting

Swahili

ASOS-2 Broadcasting

Zulu

ASOS-2 Zulu Broadcasting

Increased Surveillance Guide

English

ASOS-2 Increased postoperative surveillance bedside guide

ASOS-2 Increased postoperative surveillance bedside guide with graphics

French

ASOS-2 Increased postoperative surveillance bedside guide

Portuguese

ASOS-2 Increased postoperative surveillance bedside guide

Swahili

ASOS-2 ONGEZEKO LA HUDUMA KWA KUFUATILIA WAGUNJWA WA UPASIAJI WALIOLAZWA.pdf

ASOS-2 Surgical Risk Calculator Score Card

English

ASOS-2 Surgical Risk Calculator Score Card

French

ASOS-2 Surgical Risk Calculator Score Card

Portuguese

ASOS-2 Surgical Risk Calculator Score Card

CRF

Intervention Arm CRF

English

ASOS-2 CRF document

French

ASOS-2 CRF document

Portuguese

ASOS-2 CRF document

Swahili

JARIBIO LA ASOS-2 FOMU YA TAARIFA KWA MATIBABU YA UFUATILIAJI WA KARIBU

Control Arm CRF

English

ASOS-2 Trial CRF Control arm

French

ASOS-2 Trial CRF Control arm

Portuguese

ASOS-2 Trial CRF Control arm

Swahili

JARIBIO LA ASOS-2 FOMU YA TAARIFA KWA MATIBABU YA KAWAIDA

ASOS-2 Trial Summary

English

ASOS-2 Study Summary

ASOS-2 Poster

ASOS-2 Poster

ASOS-2 Trial Guides

ASOS-2 Trial REDCap User Guide

ASOS-2 Trial REDCap User Guide

ASOS-2 GCP Guide

ASOS-2 Trial GCP Guidelines

ASOS-2 Trial Screening Tool Guide

Screening Tool Guide

Screening Tool Guide French

ASOS-2 Trial Paper Screening Tool

ASOS-2 Trial Paper Screening Tool.pdf

ASOS-2 Patient Consent Forms - Tanzania

PARTICIPANT INFORMATION SHEET AND CONSENT FORM

JARIBIO LA ASOS -2 FOMU YA TAARIFA KWA MATIBABU YA KAWAIDA

Participating Countries

Countries confirmed to be participating in ASOS-2:

  • Algeria

  • National Leader: Mehyaoui Ryad

  • Benin

  • National Leader: Eugene Zoumenou

  • Botswana

  • National Leader: Dr Alemayehu Ginbo Bedada

  • Burkina Faso

  • National Leader: Prof Ouedraogo Nazinigouba

  • Burundi

  • National Leader: Dr Barendegere Venerand

  • Cameroon

  • National Leader: Prof Paul Owono Etoundi

  • Central African Republic

    National Leader: Dr Boniface Ngboh-Kassa Kainy

  • Democratic Republic of the Congo

  • National Leader: Dr Dolly Munlemvo

  • Egypt

  • National Leader: Prof Maher Fawzy
    National Leader: Dr Mahmoud Elfiky

  • Ethiopia

  • National Leader: Dr Daniel Zemenfes Ashebir

  • Gambia

  • National Leader: Dr Ahmadou Lamin Samateh

  • Ghana

  • National Leader: Dr Akwasi Antwi-Kusi

  • Ivory Coast

    National Leader: Dr Narcisse Boua

  • Kenya

  • National Leader: Andrew Ndonga

  • Libya

  • National Leader: Prof Mohamed Ahmed Elfagieh
    National Leader: Dr Abdulaziz Elkhogia

  • Madagascar

  • National Leader: Dr Raherison Aristide Romain
    National Leader: Dr Rakotoarison Sylvia

  • Malawi

  • National Leader: Dr Wakisa Mulwafu
    National Leader: Prof Gregor Pollach

  • Mali

  • National Leader: Pr Coulibaly Youssouf

  • Mauritius

  • National Leader: Dr Veekash Gobin

  • Namibia

  • National Leader: Dr Apollo Basenero

  • Niger

  • National Leader: Dr Chaibou Maman Sani

  • Nigeria

  • National Leader: Dr Akinyinka Omigbodun
    National Leader: Prof Simbo Amanor-Boadu

  • Rwanda

  • National Leader: Dr Mpirimbanyi Christophe

  • Sierra Leone

  • National Leader: Dr Isaac Olufemi Smalle

  • South Africa

  • National Leader: Prof Hyla Kluyts

    Please contact the lead investigator in your province if you are interested in lead ASOS-2 Trial at your site

    • Gauteng: Dr Jones Omoshoro-Jones
    • Gauteng: Dr Motselisi Mbeki
    • Kwa-Zulu Natal: Dr Alex Torborg
    • Mpumalanga: Dr Nic Procter
    • Western Cape: Dr Esther Cloete
    • Free State: Prof Gillian Lamacraft
    • Limpopo: Dr Tsakani Mhlari
    • Northern Cape: Dr Philip Anderson
    • North West: Dr Annamarie Steyn
    • Eastern Cape: Dr Busisiwe Mrara


  • Swaziland

  • National Leader: Dr David Polepole

  • Sudan

  • National Leader: Dr Tarig Fadalla

  • Tanzania

  • National Leader: Dr Mpoki Ulisubisya

  • Togo

  • National Leader: Dr Sama Doles Hamza

  • Uganda

  • National Leader: Dr Janat Tumukunde
    National Leader: Dr Adam Hewitt-Smith

  • Zambia

  • National Leader: Dr Ushmaben Patel-Mujajati

  • Zimbabwe

  • National Leader: Dr Farai Madzimbamuto

If you want to participate in the ASOS-2 Trial feel free to contact us at This email address is being protected from spambots. You need JavaScript enabled to view it.