Impact of Perioperative Malaria Screening and Treatment on Surgical Outcomes at the Eastern Regional Hospital, Koforidua: A Single-Blind Randomised Controlled Trial

Abstract

Background: Although there are suggestions that perioperative malaria infection affects surgical outcomes, screening and treatment is not done routinely in the practice of surgery in Ghana. This study examined the impact of perioperative malaria screening and treatment on surgical outcomes in the Eastern Regional Hospital, Koforidua. Methodology: A single-blind randomised controlled trial was conducted. Patients admitted for various surgeries were randomised to either undergo perioperative screening for malaria and treatment if positive, or to a control arm where no screening was done. All participants were followed-up to 30 days’ post-operation to document the incidence of adverse surgical outcomes. The differences in incidences of the outcomes were analysed by intention to treat. Results: In total, 443 patients (226 interventions and 217 controls) with various indications for surgery were enrolled between August and November, 2022. Ten (4.4%) in the intervention arm screened positive and were treated for malaria. Overall, 20% (88/443) developed poor surgical outcomes. There was borderline evidence of a 27% risk reduction in the intervention compared to the controls, with a possible 50% reduction as well as 7% increase in the risk of poor surgical outcomes (RR=0.73, 95%CI: 0.50-1.07, p=0.1). After adjusting for residual confounding, there was a statistically significant 67% reduction in the risk of prolonged hospitalisation for participants in the intervention compared to the control arm (aRR=0.33; 95% CI: 0.12-0.85; p=0.022). Conclusion: Prevalence of malaria among surgical patients at the Eastern Regional Hospital was low. However, there is suggestion that screening and treating malaria may improve surgical outcomes.