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

Autori
GlobalSurg, Collaborative ; Karlo, Robert ; Domini, Edgar ; Mihanović, Jakov

Izvornik
British Journal of Surgery (0007-1323) 103 (2016), 8; 971-988

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
mortality ; emergency ; abdominal surgery

Sažetak
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.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA