@article { , title = {Mortality of emergency abdominal surgery in high-, middle- and low-income countries}, 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).}, doi = {10.1002/bjs.10151}, eissn = {0007-1323}, issn = {0007-1323}, issue = {8}, journal = {British Journal of Surgery}, note = {UoN participator: Jonathan Lund, Division of Clinical sciences, School of Medicine Publisher's PDF not allowed. AAM required [chased up MJB 23.02.2017]. OL 12.05.2017}, publicationstatus = {Published}, publisher = {Wiley}, url = {https://nottingham-repository.worktribe.com/output/798288}, volume = {103}, year = {2016}, author = {GlobalSurg Collaborative,} }