Mortality of emergency abdominal surgery in high-, middle- and low-income countries

GlobalSurg Collaborative

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).

Citation

GlobalSurg Collaborative. (2016). Mortality of emergency abdominal surgery in high-, middle- and low-income countries. British Journal of Surgery, 103(8), https://doi.org/10.1002/bjs.10151

• Journal Article Type: Article
• Acceptance Date: Feb 10, 2016
• Online Publication Date: May 4, 2016
• Publication Date: Jul 31, 2016
• Deposit Date: May 12, 2017
• Journal: British Journal of Surgery
• Print ISSN: 0007-1323
• Electronic ISSN: 0007-1323
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 103
• Issue: 8
• DOI: https://doi.org/10.1002/bjs.10151
• Public URL: https://nottingham-repository.worktribe.com/output/798288
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1002/bjs.10151/abstract