| Contributors: |
F Fitzgerald, J E; Khatri, C; C Glasbey, J; Mohan, M; Lilford, R; M Harrison, E; Holmer, H; Hall, N; Kim, S-H; Negida, A; Jaffry, Z; J Chapman, S; Shu, S; Shiwani, H; Jeyakumar, J; Fermani, C; Balmaceda, R; Marta Modolo, M; Macdermid, E; Gobin, N; Chenn, R; Ou Yong, C; Edye, M; Jarmin, M; K D'amours, S; Iyer, D; Youssef, D; Phillips, N; Brown, J; George, R; Koh, C; Warren, O; Hanley, I; Dickfos, M; Nawara, C; Öfner, D; Primavesi, F; R Mitul, A; Mahmud, K; Hussain, M; Hakim, H; Kumar, T; Oosterkamp, A; A Assouto, P; Lawani, I; Imorou Souaibou, Y; Kyaw Tun, A; Leung Chong, C; H Devadasar, G; Rashid Minhas Qadir, M; Phyo Aung, K; Shi Yeo, L; D Palomino Castillo, V; Moron Munhoz, M; Moreira, G; C Barros De Castro Segundo, L; Anderson Khouri Ferreira, S; Cassa Careta, M; Binna Kim, S; Venâncio De Sousa, A; Daltri Lazzarini Cury, A; Peixoto Soares Miguel, G; Vega Carreiro De Freitas, A; Pereira Silvestre, B; Guasti Pinto Vianna, J; Oliveira Felipe, C; Alberto Valente Laufer, L; Altoe, F; Ayres Da Silva, L; L Pimenta, M; Fernandes Giuriato, T; Alves Bezerra Morais, P; Souza Luiz, J; Araujo, R; Menegussi, J; Leal, M; Vinícius Barroso de Lima, C; Sarmento Tatagiba, L; Leal, A; Vinicius Dos Santos, D; Pereira Fraga, G; Lages Simoes, R; Stock, S; Nigo, S; Kabba, J; Ebogo Ngwa, T; King, S; Zani, A; Azzie, G; Firdouse, M; Kushwaha, S; Agarwal, A; Bailey, K; Cameron, B; Livingston, M; Horobjowsky, A; L Deckelbaum, D |
| Description: |
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). |