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Title: Global Patient Outcomes After Elective Surgery: Prospective Cohort Study in 27 Low-, Middle- and High-Income Countries
Author: Nolasco, F
International Surgical Outcomes Study Group.
Keywords: HCC NEF
Critical Care/utilization
Elective Surgical Procedures/adverse effects
Elective Surgical Procedures/mortality
Global Health/statistics & numerical data
Hospital Mortality
Length of Stay/statistics & numerical data
Postoperative Complications/epidemiology
Prospective Studies
Socioeconomic Factors
Treatment Outcome
Issue Date: 2016
Publisher: Elsevier
Citation: Br J Anaesth. 2016 Oct 31;117(5):601-609
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.
Peer review: yes
DOI: 10.1093/bja/aew316
Appears in Collections:NEF - Artigos

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