2 research outputs found
Mortality of emergency abdominal surgery in high-, middle- and low-income countries
Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).
Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.
Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1â‹…6 per cent at 24 h (high 1â‹…1 per cent, middle 1â‹…9 per cent, low 3â‹…4 per cent; P < 0â‹…001), increasing to 5â‹…4 per cent by 30 days (high 4â‹…5 per cent, middle 6â‹…0 per cent, low 8â‹…6 per cent; P < 0â‹…001). Of the 578 patients who died, 404 (69â‹…9 per cent) did so between 24 h and 30 days following surgery (high 74â‹…2 per cent, middle 68â‹…8 per cent, low 60â‹…5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2â‹…78, 95 per cent c.i. 1â‹…84 to 4â‹…20) and low-income (OR 2â‹…97, 1â‹…84 to 4â‹…81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days.
Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)