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

Self-reported hearing loss and manual audiometry: a rural versus urban comparison

Objective: To examine whether self-reported hearing difficulty is an accurate measure of hearing loss compared with standard hearing screening with pure tone audiometry in rural and urban communities. Design: Convenience sampling. Setting: Urban and rural areas of Western Australia. Participants: A total of 2090 participants (923 men; 1165 women; 2 unknown) aged 20-100 years presenting for community-based hearing screening in urban (982) and rural (1090) areas. Interventions: Self-reported hearing difficulty assessed with the Hearing Handicap Inventory for the Elderly - Screening questionnaire. Hearing loss defined as average hearing thresholds >25dB in the better ear using screening audiometry conducted at 500, 1000, 2000 and 4000Hz. Main outcome measures: Nil. Results: The Hearing Handicap Inventory for the Elderly - Screening was sensitive (≥60 years=76.69%