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

Publication ,  Journal Article
International Surgical Outcomes Study group,
Published in: Br J Anaesth
October 31, 2016

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

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Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

October 31, 2016

Volume

117

Issue

5

Start / End Page

601 / 609

Location

England

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Socioeconomic Factors
  • Prospective Studies
  • Poverty
  • Postoperative Complications
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
 

Citation

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International Surgical Outcomes Study group, . (2016). Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth, 117(5), 601–609. https://doi.org/10.1093/bja/aew316
International Surgical Outcomes Study group, Michael. “Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.Br J Anaesth 117, no. 5 (October 31, 2016): 601–9. https://doi.org/10.1093/bja/aew316.
International Surgical Outcomes Study group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth. 2016 Oct 31;117(5):601–9.
International Surgical Outcomes Study group, Michael. “Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.Br J Anaesth, vol. 117, no. 5, Oct. 2016, pp. 601–09. Pubmed, doi:10.1093/bja/aew316.
International Surgical Outcomes Study group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth. 2016 Oct 31;117(5):601–609.
Journal cover image

Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

October 31, 2016

Volume

117

Issue

5

Start / End Page

601 / 609

Location

England

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Socioeconomic Factors
  • Prospective Studies
  • Poverty
  • Postoperative Complications
  • Middle Aged
  • Male
  • Length of Stay
  • Humans