Surgical Patient Mortality Triple in Lower Income Countries

Patients undergoing emergency abdominal surgery in lower income countries have a three times greater chance of dying than in higher income countries, according to a new study.

Researchers at the University of Birmingham (United Kingdom), the University of Edinburgh (United Kingdom), and other institutions in the GlobalSurg Collaborative conducted a prospective, multicentre, cohort study involving 10,745 hospital patients from 357 medical centers in 58 participating countries who were monitored for up to 30 days after undergoing emergency abdominal surgery. The researchers monitored post-surgery death rates and mapped them against the Human Development Index (HDI) of each country.

Study participants included 6,538 patients from high HDI countries, 2,889 from middle HDI countries, and 1,318 from low-HDI countries. The overall mortality rate was 1.6% at 24 hours, but when separated by setting, the high HDI rate was 1.1%, the middle HDI rate was 1.9%, and the low HDI setting rate was 3.4%. This increased to 5.4% by 30 days (high 4.5%, middle 6%, low 8.6%. Of the 578 patients who died, 69.9% did so between 24 hours and 30 days following surgery, and was higher in middle-income and low-income countries. The study was published on May 4, 2016, in the British Journal of Surgery.

"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," concluded lead author Aneel Bhangu, MD, of the University of Birmingham, and colleagues. "The association between increasingly mortality and lower income countries might be explained by differences in prognosis, in treatment, or maybe both. What we can say is that our study highlights the significant disparity between countries, and an urgent need to address it."

GlobalSurg is an international collaboration of doctors that have developed a novel model of data collection largely using social media, based on a sharing platform accessible from smartphones and other mobile internet devices. This allows GlobalSurg members to collect data on real patients, at the bedside, and measure surgical outcomes in real-time. One of the findings was that surgical safety checklist use was less frequent in low- and middle-income countries, but when used it was associated with reduced mortality at 30 days.

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