Open surgery for chronic venous insufficiency due to primary varicose veins in Tanzania: a retrospective cohort study at a national cardiovascular referral center

Chronic venous insufficiency (CVI) due to primary varicose veins is under-reported in sub-Saharan Africa, where patients frequently present with advanced disease and open surgery remains widely used. We hypothesised that advanced clinical disease, particularly active venous ulceration, would be associated with a lower probability of a good short-term postoperative outcome. This study described the clinical and operative profile of patients undergoing open venous surgery and assessed factors associated with good outcomes at a national cardiovascular referral center in Tanzania. We conducted a retrospective cohort study of adults aged ≥ 18 years who underwent open surgery for CVI due to primary varicose veins at Jakaya Kikwete Cardiac Institute between 1 January and 30 December 2023 and had a documented postoperative assessment 3–6 months after surgery. Data were abstracted from clinical records. The primary endpoint was a record-based composite outcome classified as good or poor using a prespecified decision rule. Descriptive statistics characterized the cohort, and logistic regression explored factors associated with a good outcome. Ninety-seven patients were analyzed; the median age was 58 years (IQR: 47–64), and 59/97 (60.8%) were male. Advanced clinical disease was common: 79/97 (81.4%) had CEAP C4 skin or subcutaneous changes, 10/97 (10.3%) had healed ulceration (C5), and 54/97 (55.7%) had active ulceration (C6); 29/97 (29.9%) had recurrent active ulceration (C6r). SFJ/GSV reflux or incompetence was documented in 89/97 (91.8%) patients, and 94/97 (96.9%) underwent SFJ/GSV high ligation with or without stripping. Overall, 67/97 (69.1%) met the study definition of a good short-term outcome. Absence of active venous ulceration was independently associated with a good outcome (aOR: 2.01; 95% CI: 1.10–4.70; p = 0.020). In this selected cohort with documented 3–6-month follow-up, 69.1% met the study-defined criteria for a good short-term postoperative outcome after open venous surgery. Patients without active venous ulceration had higher odds of a good outcome than those presenting with active ulcers. These findings highlight the burden of advanced venous disease in this surgical population and suggest that disease severity at presentation may be relevant to short-term postoperative outcomes.