Mortality of emergency abdominal surgery in high-, middle- and low-income countries
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 co...
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| Format: | Article |
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Wiley
2016
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| Online Access: | https://eprints.nottingham.ac.uk/42807/ |
| _version_ | 1848796572540731392 |
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| author | GlobalSurg Collaborative |
| author_facet | GlobalSurg Collaborative |
| author_sort | GlobalSurg Collaborative |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| 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). |
| first_indexed | 2025-11-14T19:50:07Z |
| format | Article |
| id | nottingham-42807 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:50:07Z |
| publishDate | 2016 |
| publisher | Wiley |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-428072020-05-04T17:58:52Z https://eprints.nottingham.ac.uk/42807/ Mortality of emergency abdominal surgery in high-, middle- and low-income countries GlobalSurg Collaborative 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). Wiley 2016-07-31 Article PeerReviewed GlobalSurg Collaborative (2016) Mortality of emergency abdominal surgery in high-, middle- and low-income countries. British Journal of Surgery, 103 (8). pp. 971-988. ISSN 0007-1323 http://onlinelibrary.wiley.com/doi/10.1002/bjs.10151/abstract doi:10.1002/bjs.10151 doi:10.1002/bjs.10151 |
| spellingShingle | GlobalSurg Collaborative Mortality of emergency abdominal surgery in high-, middle- and low-income countries |
| title | Mortality of emergency abdominal surgery in high-, middle- and low-income countries |
| title_full | Mortality of emergency abdominal surgery in high-, middle- and low-income countries |
| title_fullStr | Mortality of emergency abdominal surgery in high-, middle- and low-income countries |
| title_full_unstemmed | Mortality of emergency abdominal surgery in high-, middle- and low-income countries |
| title_short | Mortality of emergency abdominal surgery in high-, middle- and low-income countries |
| title_sort | mortality of emergency abdominal surgery in high-, middle- and low-income countries |
| url | https://eprints.nottingham.ac.uk/42807/ https://eprints.nottingham.ac.uk/42807/ https://eprints.nottingham.ac.uk/42807/ |