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Global patient outcomes after elective surgery: Prospective cohort study in 27 low-, middle- and high-income countries

Global patient outcomes after elective surgery: Prospective cohort study in 27 low-, middle- and high-income countries
Global patient outcomes after elective surgery: Prospective cohort study in 27 low-, middle- and high-income countries

Background: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. Methods: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. Results: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. Conclusions: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care.

cohort studies, critical care/utilisation, operative/mortality, postoperative care/methods, postoperative care/statistics and numerical data, surgery, surgical procedures
0007-0912
601-609
Grocott, Mike
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Bennett, Michael
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Jones, Philip
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Hall, Richard
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Hall, Kathryn
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Foster, Rebecca
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Milne, David
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The International Surgical Outcomes Study group
Grocott, Mike
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Bennett, Michael
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Jones, Philip
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Hall, Richard
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Yang, Jian
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Yang, Yang
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He, Miao
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Zhang, Yan
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Wang, Jun
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Lin, Hong
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Zhang, Min
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Chen, Hong
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Li, Hui
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Li, Bo
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The International Surgical Outcomes Study group (2016) Global patient outcomes after elective surgery: Prospective cohort study in 27 low-, middle- and high-income countries. British Journal of Anaesthesia, 117 (5), 601-609. (doi:10.1093/bja/aew316).

Record type: Article

Abstract

Background: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. Methods: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. Results: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. Conclusions: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care.

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1-s2.0-S0007091217300181-main (1) - Version of Record
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Accepted/In Press date: 8 August 2016
Published date: 1 November 2016
Keywords: cohort studies, critical care/utilisation, operative/mortality, postoperative care/methods, postoperative care/statistics and numerical data, surgery, surgical procedures

Identifiers

Local EPrints ID: 429703
URI: http://eprints.soton.ac.uk/id/eprint/429703
ISSN: 0007-0912
PURE UUID: 604663ef-2e94-461b-b175-b97ccd31a6f5
ORCID for Mike Grocott: ORCID iD orcid.org/0000-0002-9484-7581

Catalogue record

Date deposited: 04 Apr 2019 16:30
Last modified: 13 Aug 2022 01:45

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Contributors

Author: Mike Grocott ORCID iD
Author: Michael Bennett
Author: Philip Jones
Author: Richard Hall
Author: Jian Yang
Author: Yang Yang
Author: Miao He
Author: Yan Zhang
Author: Jun Wang
Author: Hong Lin
Author: Yang Liu
Author: Min Zhang
Author: Yuan Zhang
Author: Weiwei Zhang
Author: Xiaoqin Li
Author: Dong Wang
Author: Hong Chen
Author: Hui Li
Author: Mei Liu
Author: Lin Xu
Author: Hongyan Zhang
Author: Jie Zhang
Author: Chen Chen
Author: Bo Li
Author: Wei Xiao
Author: Jin Wang
Author: Yi Liu
Author: Rachel Bell
Author: John Armstrong
Author: Stephen John Roberts
Author: Robert Johnson
Author: Frank Anderson
Author: David L. Skinner
Author: Megan Thomas
Author: Sarah Williams
Author: Vikas Kaura
Author: Neil Smith
Author: David Adams
Author: Stephanie Jones
Author: Matthew Martin
Author: James Self
Author: Christopher Smith
Author: Victoria Bennett
Author: Richard Brown
Author: Pawan Kumar
Author: James Gill
Author: Emma Jane Smith
Author: Andrew Brown
Author: Kathryn Hall
Author: Rebecca Foster
Author: David Milne
Author: Lee Tbaily
Author: Stephen Phillips
Author: James Richardson
Author: Steve White
Author: Sally Anne Pearson
Author: Andrew Macalister Hall
Author: Robert Walker
Author: Charlotte Anderson
Author: Andrew Smith
Author: Thomas Owen
Author: Eleanor Jones
Author: Megan Lewis
Author: Hannah Collins
Author: Mark Edwards
Author: Denny Levett
Author: Hannah Payne
Author: Thomas Smith
Author: Alice Stevens
Corporate Author: The International Surgical Outcomes Study group

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