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

GlobalSurg Collaborative

Research output: Contribution to journalArticle

79 Citations (Scopus)

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).

Original languageEnglish
Pages (from-to)971-988
Number of pages18
JournalBritish Journal of Surgery
Volume103
Issue number8
DOIs
Publication statusPublished - 1 Jul 2016

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Emergencies
Mortality
Human Development
Odds Ratio
Social Adjustment
Patient Safety
Checklist
Ambulatory Surgical Procedures
Multicenter Studies
Cohort Studies
Logistic Models
Safety

ASJC Scopus subject areas

  • Surgery

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Mortality of emergency abdominal surgery in high-, middle- and low-income countries. / GlobalSurg Collaborative.

In: British Journal of Surgery, Vol. 103, No. 8, 01.07.2016, p. 971-988.

Research output: Contribution to journalArticle

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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).",
author = "{GlobalSurg Collaborative} and A. Bhangu and Fitzgerald, {J. E.F.} and S. Fergusson and C. Khatri and H. Holmer and K. S{\o}reide and Harrison, {E. M.} and Drake, {T. M.} and A. Bhangu and N. Gobin and {Vega Freitas}, A. and N. Hall and Kim, {S. H.} and A. Negida and Z. Jaffry and Chapman, {S. J.} and Arnaud, {A. P.} and S. Tabiri and G. Recinos and M. Mohan and R. Amandito and M. Shawki and M. Hanrahan and F. Pata and J. Zilinskas and Roslani, {A. C.} and Goh, {C. C.} and Ademuyiwa, {A. O.} and G. Irwin and S. Shu and L. Luque and H. Shiwani and A. Altamimi and {Ubaid Alsaggaf}, M. and R. Spence and S. Rayne and J. Jeyakumar and Y. Cengiz and Raptis, {D. A.} and Glasbey, {J. C.} and C. Fermani and R. Balmaceda and {Marta Modolo}, M. and E. Macdermid and R. Chenn and {Ou Yong}, C. and M. Edye and M. Jarmin and D'amours, {S. K.} and {Nik Mahmood}, {Nik Ritza Kosai}",
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T1 - Mortality of emergency abdominal surgery in high-, middle- and low-income countries

AU - GlobalSurg Collaborative

AU - Bhangu, A.

AU - Fitzgerald, J. E.F.

AU - Fergusson, S.

AU - Khatri, C.

AU - Holmer, H.

AU - Søreide, K.

AU - Harrison, E. M.

AU - Drake, T. M.

AU - Bhangu, A.

AU - Gobin, N.

AU - Vega Freitas, A.

AU - Hall, N.

AU - Kim, S. H.

AU - Negida, A.

AU - Jaffry, Z.

AU - Chapman, S. J.

AU - Arnaud, A. P.

AU - Tabiri, S.

AU - Recinos, G.

AU - Mohan, M.

AU - Amandito, R.

AU - Shawki, M.

AU - Hanrahan, M.

AU - Pata, F.

AU - Zilinskas, J.

AU - Roslani, A. C.

AU - Goh, C. C.

AU - Ademuyiwa, A. O.

AU - Irwin, G.

AU - Shu, S.

AU - Luque, L.

AU - Shiwani, H.

AU - Altamimi, A.

AU - Ubaid Alsaggaf, M.

AU - Spence, R.

AU - Rayne, S.

AU - Jeyakumar, J.

AU - Cengiz, Y.

AU - Raptis, D. A.

AU - Glasbey, J. C.

AU - Fermani, C.

AU - Balmaceda, R.

AU - Marta Modolo, M.

AU - Macdermid, E.

AU - Chenn, R.

AU - Ou Yong, C.

AU - Edye, M.

AU - Jarmin, M.

AU - D'amours, S. K.

AU - Nik Mahmood, Nik Ritza Kosai

PY - 2016/7/1

Y1 - 2016/7/1

N2 - 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).

AB - 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).

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