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Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries
Journal article   Open access   Peer reviewed

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries

T. Ahmad, R. A. Bouwman, I. Grigoras, C. Aldecoa, C. Hofer, A. Hoeft, P. Holt, L. A. Fleisher, W. Buhre, R. M. Pearse, …
British journal of anaesthesia : BJA, Vol.117(5), pp.601-609
11/01/2016
DOI: 10.1093/bja/aew316
url
https://doi.org/10.1093/bja/aew316View
Published (Version of record) Open Access

Abstract

Background: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. Methods: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. Results: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with amedian hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. Conclusions: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care.
 Anesthesiology Life Sciences & Biomedicine Science & Technology

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