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Showing content from https://pubmed.ncbi.nlm.nih.gov/27145169/ below:

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

Observational Study

Collaborators

• PMID: 27145169
• DOI: 10.1002/bjs.10151

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Observational Study

GlobalSurg Collaborative. Br J Surg. 2016 Jul.

• PMID: 27145169
• DOI: 10.1002/bjs.10151

Item in Clipboard

• Errata.

  [No authors listed] [No authors listed] Br J Surg. 2017 Apr;104(5):632. doi: 10.1002/bjs.10463. Epub 2017 Jan 17. Br J Surg. 2017. PMID: 28295250 No abstract available.

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).

© 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

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