Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.
Abstract
<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.<h4>Study registration</h4>ISRCTN51817007
Type
Journal articleSubject
International Surgical Outcomes Study groupHumans
Postoperative Complications
Treatment Outcome
Critical Care
Length of Stay
Hospital Mortality
Prospective Studies
Poverty
Socioeconomic Factors
Adolescent
Adult
Aged
Aged, 80 and over
Middle Aged
Female
Male
Young Adult
Global Health
Elective Surgical Procedures
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https://hdl.handle.net/10161/26271Published Version (Please cite this version)
10.1093/bja/aew316Publication Info
International Surgical Outcomes Study group (2016). Global patient outcomes after elective surgery: prospective cohort study in 27 low-,
middle- and high-income countries. British journal of anaesthesia, 117(5). pp. 601-609. 10.1093/bja/aew316. Retrieved from https://hdl.handle.net/10161/26271.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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