Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

POLICYFORUM ECONOMICS The MPG Illusion

Using “miles per gallon ” as a measure of fuel efficiency leads people to undervalue the benefits of replacing the most inefficient automobiles

Judgmental aggregation strategies depend on whether the self is involved

We report the results of a novel experiment that addresses two unresolved questions in the judgmental forecasting literature. First, how does combining the estimates of others differ from revising one's own estimate based on the judgment of another? The experiment found that participants often ignored advice when revising an estimate but averaged estimates when combining. This was true despite receiving identical feedback about the accuracy of past judgments. Second, why do people consistently tend to overweight their own opinions at the expense of profitable advice? We compared two prominent explanations for this, differential access to reasons and egocentric beliefs, and found that neither adequately accounts for the overweighting of the self. Finally, echoing past research, we find that averaging opinions is often advantageous, but that choosing a single judge can perform well in certain predictable situations.Advice taking Averaging judgments Combining opinions Information integration Judgmental forecasting

Erratum--Intuitions About Combining Opinions: Misappreciation of the Averaging Principle

Due to an error in typesetting, Figures 1-4 and Tables 1-3 were incorrectly labeled as part of this paper in Management Science, Vol. 52, No. 1, January 2006, pp. 111-127. The figures and tables are reprinted correctly below and in the electronic version.