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

TY - JOUR

T1 - Global patient outcomes after elective surgery

T2 - prospective cohort study in 27 low-, middle- and high-income countries

AU - International Surgical Outcomes Study group

AU - Kunst, Gudrun

N1 - © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.

PY - 2016/10/31

Y1 - 2016/10/31

N2 - 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 a median 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.STUDY REGISTRATION: ISRCTN51817007

AB - 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 a median 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.STUDY REGISTRATION: ISRCTN51817007

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Critical Care/statistics & numerical data

KW - Elective Surgical Procedures/adverse effects

KW - Female

KW - Global Health/statistics & numerical data

KW - Hospital Mortality

KW - Humans

KW - Length of Stay/statistics & numerical data

KW - Male

KW - Middle Aged

KW - Postoperative Complications/epidemiology

KW - Poverty

KW - Prospective Studies

KW - Socioeconomic Factors

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1093/bja/aew316

DO - 10.1093/bja/aew316

M3 - Article

C2 - 27799174

SN - 0007-0912

VL - 117

SP - 601

EP - 609

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 5

ER -