TY - JOUR
T1 - Global patient outcomes after elective surgery
T2 - Prospective cohort study in 27 low-, middle- and high-income countries
AU - The International Surgical Outcomes Study group
AU - Pearse, Rupert M.
AU - Clavien, Pierre Alain
AU - Demartines, Nicolas
AU - Fleisher, Lee A.
AU - Grocott, Mike
AU - Haddow, James
AU - Holt, Peter
AU - Moreno, Rui
AU - Pritchard, Naomi
AU - Rhodes, Andrew
AU - Wilson, Matt
AU - Ferguson, Marissa
AU - Macmahon, Michael
AU - Shulman, Mark
AU - Cherian, Ritchie
AU - Currow, Helen
AU - Kanathiban, Kathirgamanathan
AU - Gillespie, David
AU - Pathmanathan, Edward
AU - Phillips, Katherine
AU - Reynolds, Jenifer
AU - Rowley, Joanne
AU - Douglas, Jeanene
AU - Kerridge, Ross
AU - Garg, Sameer
AU - Bennett, Michael
AU - Jain, Megha
AU - Alcock, David
AU - Terblanche, Nico
AU - Cotter, Rochelle
AU - Leslie, Kate
AU - Stewart, Marcelle
AU - Zingerle, Nicolette
AU - Clyde, Antony
AU - Hambidge, Oliver
AU - Rehak, Adam
AU - Cotterell, Sharon
AU - Huynh, Wilson Binh Quan
AU - McCulloch, Timothy
AU - Ben-Menachem, Erez
AU - Egan, Thomas
AU - Cope, Jennifer
AU - Halliwell, Richard
AU - Fellinger, Paul
AU - Haisjackl, Markus
AU - Haselberger, Simone
AU - Holaubek, Caroline
AU - Lichtenegger, Paul
AU - Scherz, Florian
AU - Williams, Sarah
N1 - Publisher Copyright:
© The Author 2016.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - 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.
AB - 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.
KW - cohort studies
KW - critical care/utilisation
KW - operative/mortality
KW - postoperative care/methods
KW - postoperative care/statistics and numerical data
KW - surgery
KW - surgical procedures
UR - http://www.scopus.com/inward/record.url?scp=84994560518&partnerID=8YFLogxK
U2 - 10.1093/bja/aew316
DO - 10.1093/bja/aew316
M3 - Article
C2 - 27799174
AN - SCOPUS:84994560518
SN - 0007-0912
VL - 117
SP - 601
EP - 609
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 5
ER -