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

International Surgical Outcomes Study (ISOS) group

doi:10.1093/bja/aew316

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

International Surgical Outcomes Study (ISOS) group

Research output: Contribution to journal › Article (Academic Journal) › peer-review

411 Citations (Scopus)

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.

Original language	English
Pages (from-to)	601-609
Number of pages	9
Journal	British Journal of Anaesthesia
Volume	117
Issue number	5
Early online date	1 Nov 2016
DOIs	https://doi.org/10.1093/bja/aew316
Publication status	Published - 13 Dec 2017

Structured keywords

Water and Environmental Engineering

Access to Document

10.1093/bja/aew316

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Cite this

@article{955dedae12ae4dab817bf83d19401dc0,

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

abstract = "BackgroundAs 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.MethodsWe 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.ResultsA 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.ConclusionsPoor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care.",

author = "{International Surgical Outcomes Study (ISOS) group} and P. Holt and A. Rhodes and M. Wilson and M. Ferguson and M. Macmahon and D. Gillespie and K. Phillips and J. Reynolds and R. Kerridge and M. Bennett and M. Stewart and A. Hartmann and T. Jacobs and D. Ortega and F. Dias and M. Machado and J. Garcia and M. Lopes and A. Carr and H.C. Yu and B. Rowe and S. Sampson and R. George and P. Jones and D. Tran and G. Dobson and R. Hall and E. Lee and A. Tsui and S. Choi and H. Dwyer and C. McCartney and J. Carroll and Y. Huang and Y. Cao and H. Gao and T. Hu and J. Yang and Y. Yang and Y. Zhong and J. Zhou and M. He and X. Li and H. Wang and L. Chen and L. Wang and Y. Cai and Y. Li and H. Sun and S. Wang and Z. Wang and K. Wang and Y. Zhu and X. Du and Y. Fu and L. Huang and Y. Huang and Z. Wang and G. Wang and S. Wang and Y. Zhang and X. Zhang and C. Chen and W. Wang and Z. Liu and L. Fan and J. Tang and Y. Chen and Y. Chen and C. Huang and J. Shen and J. Wang and Q. Yang and H. Zhou and J. Chen and Z. Chen and X. Li and X. Zhang and Y. Bi and J. Cao and H. Lin and Y. Liu and C. Sun and Y. Sun and Y. Wang and S. Wang and M. Zhang and Z. Shen and Y. Zhang and B. Zhao and X.-J. Zhou and Q. Chen and H. Guo and Y. Guo and Y. Qi and W. Zhang and L. Zheng and Y. Chen and Y. Chen and X. Hu and X. Li and C. Shen and Y. Sun and Y. Wang and D. Wang and C. Wu and L. Xu and J. Yuan and L. Zhang and H. Zhang and Y. Zhang and J. Zhao and C. Zhao and H. Zhou and C. Zhou and H. Chen and S. Chen and J. He and C. Li and H. Li and Y. Pan and Y. Shi and S. Wu and K. Zhang and B. Zhao and F. Chen and X. Lin and G. Liu and J. Tao and L. Yang and J. Zhou and F. Chen and Z. Cheng and Y. Feng and B. Hou and C.H. Hu and H. Huang and J. Huang and Z. Jiang and M. Li and J. Lin and M. Liu and W. Liu and Z. Liu and L. Ma and J. Min and Z. Song and Y. Xiong and L. Xu and S. Yang and Q. Zhang and H. Zhang and H. Zhang and X. Zhang and W. Zhao and W. Zhao and X. Zhu and L. Chen and S. Chen and Q. Dai and K. Han and X. He and L. Huang and D. Jia and S. Jin and Q. Li and S. Luo and Y. Pan and M. Qian and J. Qin and Y. Shi and J. Wang and J. Wang and L. Wang and Y. Yan and Y. Yao and M. Zhang and J. Zhao and L. He and L. Huang and Z. Li and H. Li and Y. Li and L. Li and Y. Yuan and E. Zhang and J. Zhang and S. Zhao and C. Chen and J. Li and Z. Wen and Y. Yu and F. Yuan and X. Hu and Y. Zhang and W. Xiao and Z. Zhu and Q. Dai and K. Fu and R. Hu and X. Hu and S. Huang and Y. Li and Y. Liang and S. Yu and Z. Guo and J. Wu and R. Zhang and X. Zhao and Y. Li and C.-X. Liu and F.-F. Liu and W. Ren and X.-L. Wang and G.-J. Xu and B. Li and Y. Ou and Y. Tang and S. Yao and S. Zhang and C.-C. Kong and B. Liu and T. Wang and W. Xiao and B. Lu and Y. Xia and J. Zhou and S. Hu and H. Wang and L. Hu and B. Li and Q. Liu and Y. Liu and X. Qiu and Q. Ren and Y. Tong and J. Wang and J. Xia and X. Xiong and S. Xu and T. Yang and J. Yuan and B. Zhang and S. Chen and Y. Fan and S. Fu and X. Ge and B. Guo and W. Huang and L. Jiang and X. Jiang and Y. Liu and Y. Pan and J. Wang and F. Wang and C. Wu and X. Zhang and K.H.W. Lange and S.H. Smith and K. Schmidt and S. Harris and G. Georgiou and S. Karatzas and E. Papadakis and A. Papaioannou and C. Bali and M.S.C. Tsang and M.S. Tang and M.L. Lai and C.P. Yip and H.M.H. Chan and W.S. Li and H.M. Chu and C.C.J. Lam and K.H. Cheng and M. Chan and W.Y. Lam and K. Wong and C.Y.J. Hung and W.K.J. Chan and S.M. Wong and C.K.E. Chung and S.K. Ma and S. Kaushik and B. Shah and S. Shah and M. Thomas and M.T. Novelli and J. Joseph and M.H.S. Shah and S.C. Tan and F.Y. Kwok and C.K. Lee and S.M. Wong and N.H. Abdullah and J.Y. Wong and J. Yong and W.K.J. Chan and Y.C. Lee and C.W. Wong and N. Hussain and H.S. Lee and J.M. Lee and D.V. Ooi and J.C.J.A. L{\'o}pez and L.P.G. Aquino and M. Ali and S. Allen and R. Bell and M. Drake and K. Holmes and N. Jenkins and C.J. Kim and S. Kim and D. McAllister and K. Park and L. Pfeifer and T. Short and J. Armstrong and N. Jenkins and L. Dixon and R. Kennedy and R. Pascoe and S.J. Roberts and G. Rowell and L. Wilson and Y.H. Chang and J. Foley and C. Fowler and L. McCann and J. Tai and C.W. Wong and T. Norton and N. Smith and C. Bennett and J. Scott and S. Davis and M. Williams and S.B. Sharma and K. Byrne and R. Johnson and R. Salter and D. Walsh and R. Cooper and K. Perry and A. Ahmad and I. Ugwu and A.C.M.M. Costa and S. Esteves and C.M. Rodrigues and S. Dias and A.A.F. Paiva and A. Hussain and I. Utkin and D.G. Bishop and C. Cairns and M.P. Hayes and C. Lee and L. Ryan and S. Adam and J. Chen and J.L. Taylor and P. Anderson and A. Singh and D.L. Skinner and M.J. Smith and B. Singh and A.G. Lopez and M. Patel and C.D. Navarro and M.L. Serrano and E. Alonso and S. Mart{\'i}n and A.P. Gonzalez and D.P. Mart{\'i}n and F.P. Mart{\'i}n and M.T. Ganter and M. Hubner and R.B.N. Khan and D. Francis and K. Ellis and G. Butt and S. Allen and J. Kemp and L. Matthews and A. Garg and J. Bradley and C. Brooks and J. Brown and G. Brown and A. Finch and S. Hesketh and G. Hill and M. Morgan and M. Thomas and A. Brennan and S. Cooper and R. Craven and K. Davies and A. Jonas and G. Walkden and H. Davies and L. Johnson and S. Williams and M. Bland and C. Naylor and N. Smith and A. Ahmed and J. Tan and S. Tripathi and A. Ghosh and T. Hughes and M.S. Khalid and D. Adams and A. King and J. Yarwood and J. Browning and J. Hatton and A. Wilson and A. Gupta and N. Lancaster and S. Jones and S. Moreton and C. Davies and M. Martin and S. Thomas and P. Patel and N. Rich and F. Davis and R. Lyons and C. Smith and V. Bennett and A. Dumitrescu and J.F. Murphy and G. Adams and R. Brown and R. Bennett and S. Bell and C. Anderson and P. Baker and M. Brookes and R. Clarkson and S. Das and V.R. Kumar and K. Stewart and A. Walker and D. Baines and P. Kumar and A. Chan and J. Gill and C. Harris and P. Hopkins and E.-J. Smith and D. Holden and N. Watson and J. Thompson and C. Kelly and S. Kelly and G. Lloyd and A. Turner and A. Brown and R. Clark and R. Pearson and L. Cooper and A. Donovan and J. Foot and A. Claxton and R. Armstrong and S. Ali and G. Baker and J. Flatt and A. Rankin and R. Horn and J. Hunt and J. Allsop and K. Smith and J. Brown and L. James and K. Smith and N. Ahmad and J. Harrison and D. Miller and S. Sanghera and R. Walker and H. Cripps and H. Daniel and J. Lynch and S. Webb and S. Buckley and R. Charles and R. Foster and S. Gill and A. Ratcliffe and A. Rose and A. Smith and J. Ward and C. Hamilton and L. Kelly and P. Gordon and J. Nightingale and S. Rose and M.A. Arshad and A. Clarkson and M. Collins and L. Cooper and E. Griffiths and K. Joory and S. Kaur and N. Mitchell and A. Nilsson and M. Pope and A. Thomas and K. Wong and J. Giles and J. Birch and C. Prince and T. Reynolds and R. Banerjee and K. Davies and J. Edwards and C. Evans and D. Ford and S. Hill and C. Kelly and J. Kennedy and S. Phillips and J. Richardson and T. Smith and N. Steele and S. White and M. Harris and C. Kelly and S.A. Pearson and A. Andrew and G. Campbell and H. King and T. Lawson and A.M. Hall and A. Ratcliffe and J. Robbins and R. Walker and R. Humphries and C. Smith and S. Ullah and A. Hellewell and M. Hutchings and D. Hutchins and A. Potter and F. Smith and L. Stone and K. Thorpe and S. Baillie and S. James and C. King and D. Martin and R. Rajendram and M. Burton and K. James and J. Morgan and T. Roberts and J. Kendall and C. Anderson and B. Harris and J. Martin and R. Thomas and C.W. Brown and M. Gillies and J. Craig and A. Smith and T. Ahmad and R. Hewson and T. Jones and D. Wang and J. Baldwin and S. Mcmullan and T. Owen and A. Williams and H. Daniel and P. Gregory and M. Harper and S. White and J. Jack and T. Cook and I. Kerslake and A. Pearson and C. Boyd and L. O'Connor and J. Scott and J. Ahmed and A. Swain and J. Brookes and R. Dolan and F. Lloyd and K. Patel and L. Brown and C. Gray and M. Hood and D. Jones and T. Walker and K. Rhodes and K.-A. Baker and W. Bertram and R. Mouton and G. Arnold and L. Baxter and J. Harris and C. Jones and A. Perera and A. Scott and S. Wright and C. Gray and S. Barrett and M. Cooper and J. Maclean and S. Meier and A. Watson and H. Ali and G. Campbell and C. Hicks and C. Thomas and S. Welsh and T. Gill and J. Johnson and J. Reed and E. Davis and C. Attwood and S. Gray and S. Mills and J. Montgomery and J. Simpson and E. Paul and M. Alexander and S. Arumugam and R. Brown and Y.L. Chan and R. Christian and M. Deacon and J. Ellis and R. English and J. Franklin and E. Garrett and H. Goss and R. Harris and E. Jones and C. Lewis and A. Milne and J.-P. Mulligan and T. Parsons and C. Thomas and A. Kennedy and S. Scott and N. Wilson and D. Wilson and M. Baldwin and J. Cornish and Z. Davies and L. Davies and M. Edwards and L. Matthews and T. Kim and S. Lawson and M. Lewis and Y. Ahmad and S. Bates and H. Bryant and H. Collins and M. Edwards and L. Hawkins and B. Skinner and J. Dickson and P. O'Brien and E. Walker and J. Brooke and S. Kumar and D. Cotterill and G. Hosdurga and E. Miles and G. Saunders and M. Campbell and P. Chan and A. Raj and E. Johnson and P. Lo and T. Martin and J. Allison and C. Carroll and N. Craw and A. McDonald and D. Simon and T. Smith and K. Campbell and F. Lu and R. Hall and A. Evans and A. Sanchez and L.-L. Chen and R. Lane and S. Patel and X. Fang and M. Hubner",

year = "2017",

month = dec,

day = "13",

doi = "10.1093/bja/aew316",

language = "English",

volume = "117",

pages = "601--609",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Oxford University Press",

number = "5",

}

TY - JOUR

T1 - Global patient outcomes after elective surgery

T2 - Prospective cohort study in 27 low-, middle- and high-income countries

AU - International Surgical Outcomes Study (ISOS) group

AU - Holt, P.

AU - Rhodes, A.

AU - Wilson, M.

AU - Ferguson, M.

AU - Macmahon, M.

AU - Gillespie, D.

AU - Phillips, K.

AU - Reynolds, J.

AU - Kerridge, R.

AU - Bennett, M.

AU - Stewart, M.

AU - Hartmann, A.

AU - Jacobs, T.

AU - Ortega, D.

AU - Dias, F.

AU - Machado, M.

AU - Garcia, J.

AU - Lopes, M.

AU - Carr, A.

AU - Yu, H.C.

AU - Rowe, B.

AU - Sampson, S.

AU - George, R.

AU - Jones, P.

AU - Tran, D.

AU - Dobson, G.

AU - Hall, R.

AU - Lee, E.

AU - Tsui, A.

AU - Choi, S.

AU - Dwyer, H.

AU - McCartney, C.

AU - Carroll, J.

AU - Huang, Y.

AU - Cao, Y.

AU - Gao, H.

AU - Hu, T.

AU - Yang, J.

AU - Yang, Y.

AU - Zhong, Y.

AU - Zhou, J.

AU - He, M.

AU - Li, X.

AU - Wang, H.

AU - Chen, L.

AU - Wang, L.

AU - Cai, Y.

AU - Li, Y.

AU - Sun, H.

AU - Wang, S.

AU - Wang, Z.

AU - Wang, K.

AU - Zhu, Y.

AU - Du, X.

AU - Fu, Y.

AU - Huang, L.

AU - Huang, Y.

AU - Wang, Z.

AU - Wang, G.

AU - Wang, S.

AU - Zhang, Y.

AU - Zhang, X.

AU - Chen, C.

AU - Wang, W.

AU - Liu, Z.

AU - Fan, L.

AU - Tang, J.

AU - Chen, Y.

AU - Huang, C.

AU - Shen, J.

AU - Wang, J.

AU - Yang, Q.

AU - Zhou, H.

AU - Chen, J.

AU - Chen, Z.

AU - Li, X.

AU - Zhang, X.

AU - Bi, Y.

AU - Cao, J.

AU - Lin, H.

AU - Liu, Y.

AU - Sun, C.

AU - Sun, Y.

AU - Wang, Y.

AU - Wang, S.

AU - Zhang, M.

AU - Shen, Z.

AU - Zhang, Y.

AU - Zhao, B.

AU - Zhou, X.-J.

AU - Chen, Q.

AU - Guo, H.

AU - Guo, Y.

AU - Qi, Y.

AU - Zhang, W.

AU - Zheng, L.

AU - Chen, Y.

AU - Hu, X.

AU - Li, X.

AU - Shen, C.

AU - Sun, Y.

AU - Wang, Y.

AU - Wang, D.

AU - Wu, C.

AU - Xu, L.

AU - Yuan, J.

AU - Zhang, L.

AU - Zhang, H.

AU - Zhang, Y.

AU - Zhao, J.

AU - Zhao, C.

AU - Zhou, H.

AU - Zhou, C.

AU - Chen, H.

AU - Chen, S.

AU - He, J.

AU - Li, C.

AU - Li, H.

AU - Pan, Y.

AU - Shi, Y.

AU - Wu, S.

AU - Zhang, K.

AU - Zhao, B.

AU - Chen, F.

AU - Lin, X.

AU - Liu, G.

AU - Tao, J.

AU - Yang, L.

AU - Zhou, J.

AU - Chen, F.

AU - Cheng, Z.

AU - Feng, Y.

AU - Hou, B.

AU - Hu, C.H.

AU - Huang, H.

AU - Huang, J.

AU - Jiang, Z.

AU - Li, M.

AU - Lin, J.

AU - Liu, M.

AU - Liu, W.

AU - Liu, Z.

AU - Ma, L.

AU - Min, J.

AU - Song, Z.

AU - Xiong, Y.

AU - Xu, L.

AU - Yang, S.

AU - Zhang, Q.

AU - Zhang, H.

AU - Zhang, X.

AU - Zhao, W.

AU - Zhu, X.

AU - Chen, L.

AU - Chen, S.

AU - Dai, Q.

AU - Han, K.

AU - He, X.

AU - Huang, L.

AU - Jia, D.

AU - Jin, S.

AU - Li, Q.

AU - Luo, S.

AU - Pan, Y.

AU - Qian, M.

AU - Qin, J.

AU - Shi, Y.

AU - Wang, J.

AU - Wang, L.

AU - Yan, Y.

AU - Yao, Y.

AU - Zhang, M.

AU - Zhao, J.

AU - He, L.

AU - Huang, L.

AU - Li, Z.

AU - Li, H.

AU - Li, Y.

AU - Li, L.

AU - Yuan, Y.

AU - Zhang, E.

AU - Zhang, J.

AU - Zhao, S.

AU - Chen, C.

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AU - Yuan, F.

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AU - Zhang, Y.

AU - Xiao, W.

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AU - Dai, Q.

AU - Fu, K.

AU - Hu, R.

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AU - Huang, S.

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AU - Wu, J.

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AU - Li, B.

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AU - Huang, W.

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AU - Wang, J.

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AU - Wu, C.

AU - Zhang, X.

AU - Lange, K.H.W.

AU - Smith, S.H.

AU - Schmidt, K.

AU - Harris, S.

AU - Georgiou, G.

AU - Karatzas, S.

AU - Papadakis, E.

AU - Papaioannou, A.

AU - Bali, C.

AU - Tsang, M.S.C.

AU - Tang, M.S.

AU - Lai, M.L.

AU - Yip, C.P.

AU - Chan, H.M.H.

AU - Li, W.S.

AU - Chu, H.M.

AU - Lam, C.C.J.

AU - Cheng, K.H.

AU - Chan, M.

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AU - Wong, K.

AU - Hung, C.Y.J.

AU - Chan, W.K.J.

AU - Wong, S.M.

AU - Chung, C.K.E.

AU - Ma, S.K.

AU - Kaushik, S.

AU - Shah, B.

AU - Shah, S.

AU - Thomas, M.

AU - Novelli, M.T.

AU - Joseph, J.

AU - Shah, M.H.S.

AU - Tan, S.C.

AU - Kwok, F.Y.

AU - Lee, C.K.

AU - Wong, S.M.

AU - Abdullah, N.H.

AU - Wong, J.Y.

AU - Yong, J.

AU - Chan, W.K.J.

AU - Lee, Y.C.

AU - Wong, C.W.

AU - Hussain, N.

AU - Lee, H.S.

AU - Lee, J.M.

AU - Ooi, D.V.

AU - López, J.C.J.A.

AU - Aquino, L.P.G.

AU - Ali, M.

AU - Allen, S.

AU - Bell, R.

AU - Drake, M.

AU - Holmes, K.

AU - Jenkins, N.

AU - Kim, C.J.

AU - Kim, S.

AU - McAllister, D.

AU - Park, K.

AU - Pfeifer, L.

AU - Short, T.

AU - Armstrong, J.

AU - Jenkins, N.

AU - Dixon, L.

AU - Kennedy, R.

AU - Pascoe, R.

AU - Roberts, S.J.

AU - Rowell, G.

AU - Wilson, L.

AU - Chang, Y.H.

AU - Foley, J.

AU - Fowler, C.

AU - McCann, L.

AU - Tai, J.

AU - Wong, C.W.

AU - Norton, T.

AU - Smith, N.

AU - Bennett, C.

AU - Scott, J.

AU - Davis, S.

AU - Williams, M.

AU - Sharma, S.B.

AU - Byrne, K.

AU - Johnson, R.

AU - Salter, R.

AU - Walsh, D.

AU - Cooper, R.

AU - Perry, K.

AU - Ahmad, A.

AU - Ugwu, I.

AU - Costa, A.C.M.M.

AU - Esteves, S.

AU - Rodrigues, C.M.

AU - Dias, S.

AU - Paiva, A.A.F.

AU - Hussain, A.

AU - Utkin, I.

AU - Bishop, D.G.

AU - Cairns, C.

AU - Hayes, M.P.

AU - Lee, C.

AU - Ryan, L.

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AU - Hughes, T.

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AU - Yarwood, J.

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AU - Davis, F.

AU - Lyons, R.

AU - Smith, C.

AU - Bennett, V.

AU - Dumitrescu, A.

AU - Murphy, J.F.

AU - Adams, G.

AU - Brown, R.

AU - Bennett, R.

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PY - 2017/12/13

Y1 - 2017/12/13

N2 - BackgroundAs 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.MethodsWe 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.ResultsA 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.ConclusionsPoor 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 - BackgroundAs 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.MethodsWe 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.ResultsA 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.ConclusionsPoor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care.

UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84994560518&partnerID=MN8TOARS

U2 - 10.1093/bja/aew316

DO - 10.1093/bja/aew316

M3 - Article (Academic Journal)

C2 - 27799174

SN - 0007-0912

VL - 117

SP - 601

EP - 609

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 5

ER -

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

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