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Mortality of emergency abdominal surgery in high-, middleand low-income countries

Authors: Ogechukwu Taiwo

Publication Type: Journal article

Journal: British Journal Of Surgery (bjs)

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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> days (high 4?5 per cent, middle 6?0 per cent, low 8?6 per cent; P < 0> 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).

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,O. . (0000). Mortality of emergency abdominal surgery in high-, middleand low-income countries, 103 (), 971-971.

,O. . "Mortality of emergency abdominal surgery in high-, middleand low-income countries" 103, no (), (0000): 971-971.

,O. and . (0000). Mortality of emergency abdominal surgery in high-, middleand low-income countries, 103 (), pp971-971.

O, . Mortality of emergency abdominal surgery in high-, middleand low-income countries. 0000, 103 ():971-971.

,Ogechukwu Taiwo , . "Mortality of emergency abdominal surgery in high-, middleand low-income countries", 103 . (0000) : 971-971.

.Ogechukwu Taiwo , "Mortality of emergency abdominal surgery in high-, middleand low-income countries" vol.103, no., pp. 971-971, 0000.

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