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Mortality of emergency abdominal surgery in high-, middle- and low-income countries
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GlobalSurg Collaborative (Including: Bhangu, A., Fitzgerald, J. E. F., Ademuyiwa, A. O., Recinos, G., Khatri, Chetan, Glasbey, J. C., Drake, T. M., Mohan, M., Lilford, Richard, Søreide, K. and Harrison, E. M. ). (2016) Mortality of emergency abdominal surgery in high-, middle- and low-income countries. British Journal of Surgery, 103 (8). pp. 971-988. doi:10.1002/bjs.10151
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Official URL: http://dx.doi.org/10.1002/bjs.10151
Abstract
Abstract
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 1·6 per cent at 24 h (high 1·1 per cent, middle 1·9 per cent, low 3·4 per cent; P < 0·001), increasing to 5·4 per cent by 30 days (high 4·5 per cent, middle 6·0 per cent, low 8·6 per cent; P < 0·001). Of the 578 patients who died, 404 (69·9 per cent) did so between 24 h and 30 days following surgery (high 74·2 per cent, middle 68·8 per cent, low 60·5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2·78, 95 per cent c.i. 1·84 to 4·20) and low-income (OR 2·97, 1·84 to 4·81) 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).
| Item Type: | Journal Article | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Divisions: | Faculty of Medicine > Warwick Medical School | ||||||||
| Journal or Publication Title: | British Journal of Surgery | ||||||||
| Publisher: | John Wiley & Sons Ltd. | ||||||||
| ISSN: | 0007-1323 | ||||||||
| Official Date: | July 2016 | ||||||||
| Dates: |
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| Volume: | 103 | ||||||||
| Number: | 8 | ||||||||
| Page Range: | pp. 971-988 | ||||||||
| DOI: | 10.1002/bjs.10151 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access |
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