Mortality of emergency abdominal surgery in high-, middle- and low-income countries
Academic Article
Publication Date:
2016
abstract:
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).
Iris type:
Articolo su Rivista
Keywords:
Surgery
List of contributors:
Bhangu, A.; Fitzgerald, J. E. F.; Fergusson, S.; Khatri, C.; Holmer, H.; Søreide, K.; Harrison, E. M.; Drake, T. M.; Bhangu, A.; Gobin, N.; Vega Freitas, A.; Hall, N.; Kim, S. -H.; Negida, A.; Jaffry, Z.; Chapman, S. J.; Arnaud, A. P.; Tabiri, S.; Recinos, G.; Mohan, M.; Amandito, R.; Shawki, M.; Hanrahan, M.; Pata, F.; Zilinskas, J.; Roslani, A. C.; Goh, C. C.; Ademuyiwa, A. O.; Irwin, G.; Shu, S.; Luque, L.; Shiwani, H.; Altamimi, A.; Ubaid Alsaggaf, M.; Spence, R.; Rayne, S.; Jeyakumar, J.; Cengiz, Y.; Raptis, D. A.; Glasbey, J. C.; Fermani, C.; Balmaceda, R.; Marta Modolo, M.; Macdermid, E.; Chenn, R.; Ou Yong, C.; Edye, M.; Jarmin, M.; D'Amours, S. K.; Iyer, D.; Youssef, D.; Phillips, N.; Brown, J.; George, R.; Koh, C.; Warren, O.; Hanley, I.; Dickfos, M.; Nawara, C.; Öfner, D.; Primavesi, F.; Mitul, A. R.; Mahmud, K.; Hussain, M.; Hakim, H.; Kumar, T.; Oosterkamp, A.; Assouto, P. A.; Lawani, I.; Imorou Souaibou, Y.; Kyaw Tun, A.; Leung Chong, C.; Devadasar, G. H.; Rashid Minhas Qadir, M.; Phyo Aung, K.; Shi Yeo, L.; Palomino Castillo, V. D.; Moron Munhoz, M.; Moreira, G.; Barros De Castro Segundo, L. C.; Anderson Khouri Ferreira, S.; Cassa Careta, M.; Binna Kim, S.; Venâncio De Sousa, A.; Daltri Lazzarini Cury, A.; Peixoto Soares Miguel, G.; Vega Carreiro De Freitas, A.; Pereira Silvestre, B.; Guasti Pinto Vianna, J.; Oliveira Felipe, C.; Alberto Valente Laufer, L.; Altoe, F.; Ayres Da Silva, L.; Pimenta, M. L.; Fernandes Giuriato, T.; Alves Bezerra Morais, P.; Souza Luiz, J.; Araujo, R.; Menegussi, J.; Leal, M.; Vinícius Barroso de Lima, C.; Sarmento Tatagiba, L.; Leal, A.; Vinicius dos Santos, D.; Pereira Fraga, G.; Lages Simoes, R.; Stock, S.; Nigo, S.; Kabba, J.; Ebogo Ngwa, T.; King, S.; Zani, A.; Azzie, G.; Firdouse, M.; Kushwaha, S.; Agarwal, A.; Bailey, K.; Cameron, B.; Livingston, M.; Horobjowsky, A.; Deckelbaum, D. L.; Razek, T.; Marinkovic, B.; Grasset, E.; D'Aguzan, N.; Jimenez, J.; Macchiavello, R.; Zhang, Z.; Guo, W.; Oh, J.; Zheng, F.; Montes, I.; Sierra, S.; Mendez, M.; Villegas, M. I.; Mendoza Arango, M. C.; Mendoza, I.; Naranjo Aristizã bal, F. A.; Montoya Botero, J. A.; Quintero Riaza, V. M.; Restrepo, J.; Morales, C.; Cruz, H.; Munera, A.; Karlo, R.; Domini, E.; Mihanovic, J.; Radic, M.; Zamarin, K.; Pezelj, N.; Hache-Marliere, M.; Batista Lemaire, S.; Rivas, R.; Khyrallh, A.; Hassan, A.; Shimy, G.; Baky Fahmy, M. A.; Nabawi, A.; Ali Muhammad Gohar, M. S.; Elfil, M.; Ghoneem, M.; Asal, M.; Abdelkader, M.; Gomah, M.; Rashwan, H.; Karkeet, M.; Gomaa, A.; Hasan, A.; Elgebaly, A.; Azzam, O.; Abdelfattah, A.; Gouda, A.; Elshafay, A.; Gharib, A.; Menshawy, A.; Hanafy, M.; Al-Mallah, A.; Abdulgawad, M.; Baheeg, M.; Alhendy, M.; Fattah, I. A.; Kenibar, A.; Osman, O.; Gemeah, M.; Mohammed, A.; Adel, A.; Sayed, A.; Abozaid, M.; Hafez El-Badri Kotb, A.; Ahmed Ata, A. A.; Nasr, M.; Alkammash, A.; Saeed, M.; Abd El Hamid, N.; Attia, A. M.; Abd El Galeel, A.; Elbanby, E.; Salah El-Dien, K.; Hantour, U.; Alahmady, O.; Mansour, B.; Elkorashy, A. M.; Saeed Taha, E. M.; Lasheen, K. T.; Said Elkolaly, S.; Yosri Elsayed Abdel-Wahab, N.; Fathi Abozyed, M. A.; Saeed, A. M.; Samir El Sayed, G.; Youssif, J. H.; Magdy Ahmed, S.; Soubhy El-Shahat, N.; Hegazy Khedr, A.; Osama Elsebaaye, A.; Elzayat, M.; Abdelraheim, M.; Elzayat, I.; Warda, M.; Naser El Deen, K.; Essam Elnemr, A.; Salah, O.; Abbas, M.; Rashad, M.; Elzayyat, I.; Hemeda, D.; Tawfik, G.; Salama, M.; Khaled, H.; Seisa, M.; Elshaer, K.; Hussein, A.; Elkhadrawi, M.; Afifi, A. M.; Saadeldeen Ebrahim, O.; Metwally, M. M.; Elmelegy, R.; Elbendary Elsawahly, D. M.; Safa, H.; Nofal, E.; Elbermawy, M.; Abo Raya, M.; Abdelmotaleb Ghazy, A.; Samih, H.; Abdelgelil, A.; Abdelghany, S.; El Kholy, A.; Elkady, F.; Salma, M.; Samy, S.; Fakher, R.; Aboarab, A.; Samir, A.; Sakr, A.; Haroun, A.; Abdel-Rahman Al-Aarag, A.; Elkholy, A.; Elshanwany, S.; Ghanem, E.; Tammam, A.; Hammad, A. M.; El Shoura, Y.; El Ashal, G.; Khairy, H.; Antar,
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