The University of Southampton
University of Southampton Institutional Repository

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

Mortality of emergency abdominal surgery in high-, middle- and low-income countries.
Mortality of emergency abdominal surgery in high-, middle- and low-income countries.
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).
1-18
Bhangu, A.
f4d282de-34dc-4ecf-b859-916df33fe4b0
Fitzgerald, J.E.F
83626c9d-411b-4a6c-9e46-5f8639f51675
Ademuyiwa, A.O.
bc6a6225-f9ff-49d2-8414-e8712c87e7e6
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Bhangu, A.
f4d282de-34dc-4ecf-b859-916df33fe4b0
Fitzgerald, J.E.F
83626c9d-411b-4a6c-9e46-5f8639f51675
Ademuyiwa, A.O.
bc6a6225-f9ff-49d2-8414-e8712c87e7e6
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf

Bhangu, A., Fitzgerald, J.E.F and Ademuyiwa, A.O. et al. (2016) Mortality of emergency abdominal surgery in high-, middle- and low-income countries. British Journal of Surgery, 1-18. (doi:10.1002/bjs.10151). (PMID:27145169)

Record type: Article

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).

Text
Collaborative-2016-British_Journal_of_Surgery.pdf - Version of Record
Restricted to Repository staff only
Request a copy

More information

Accepted/In Press date: 10 February 2016
e-pub ahead of print date: 4 May 2016
Additional Information: GlobalSurg Collaborative
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 394739
URI: https://eprints.soton.ac.uk/id/eprint/394739
PURE UUID: e805ec92-d18b-48eb-a20e-23c92aa02cf0
ORCID for Nigel Hall: ORCID iD orcid.org/0000-0001-8570-9374

Catalogue record

Date deposited: 23 May 2016 14:07
Last modified: 20 Jul 2019 00:45

Export record

Altmetrics

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×