Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery – a prospective cohort studyResearch in context

Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators t...

Full description

Saved in:

Bibliographic Details
Published in:	Lancet Regional Health - Americas (Online) Vol. 38; p. 100862
Main Authors:	Carlos J. Pérez Rivera, Nicolás Lozano-Suárez, Alejandro Velandia-Sánchez, Maria Paula Vargas-Cuellar, Luisa Fernanda Rojas-Serrano, Camilo A. Polanía-Sandoval, Daniela Lara-Espinosa, Laura García-Zambrano, Maria Paz Bohórquez-Tarazona, Silvia Valentina Agudelo-Mendoza, Paulo A. Cabrera-Rivera, Leonardo Briceno-Ayala, Camilo Andres Polania-Sandoval, María Paula Vargas-Cuéllar, Paulo Andrés Cabrera-Rivera, Danna Cruz-Reyes, Juan Guillermo Barrera Carvajal, Luis Felipe Cabrera-Vargas, Oscar Guevara, Laura Cristina Arce Polania, Laura Natalia Buendía Barrios, María Isabel Cristina Camargo Areyanes, Felipe Casas, Valeria Cormane Alfaro, Juan P. García-Méndez, Bayron Guerra, Sharon V. Idarraga-Ayala, Akram Kadamani Abiyomaa, Christopher Montoya, Manuel Santiago Mosquera Paz, María Alejandra Pineda, Juliana Pinzón-Luna, Isabella Roa Bastidas, Carlos Fernando Roman Ortega, Juan D. Saavedra Henao, Laura Carolina SanJuan-Arias, Vanessa Barreto, Julian Corso, Mariana Maksoud-Garcia, Eliana Pineda Mateus, Alejandra Vega Zabaraín, Fabien Mantilla-Sylvain, Nicolas Perez, Sergio Alzate-Ricaurte, Monica Bejarano, Isabella Caicedo Holguin, Alberto Federico García, Stefania Rodriguez Sanchez, Felipe Bernal Santos, Carlos Luna Jaspe, Maria Camila Luna-Jaspe Roa, Maria Paula OLIVERA Bolívar, MariaFernanda Valdivieso Diaz, Yuli Agudelo, Maria Paula Castillo-Aristizábal, Juan Pablo Hoyos Burgos, Maria Clara Maria Clara Mendoza Arango, Gabriel Arroyave, Felipe Buitrago Preciado, Lina María Cardona González, Juan Camilo Correa-Cote, Karen Lorena Franco Arias, Juan Felipe Llano Sierra, Gustavo López, Cesar Mancero, Sebastian Parra, Beatriz Ramirez Gonzalez, Daniela Sierra, Maria Camila Amaya Muñoz, Ashley Blanco-Ramírez, Paul Anthony Camacho, Jorge Campillo, Andrea Ximena Carvajal Mejia, María Alejandra González Yamil, Juan Carlos Osorno Villegas, Eduardo Rubio, Santiago Sánchez Herrera, Sebastian Sanchez Herrera, Tatiana Agudelo, Valentina Andrade, Laura Arango Pérez, Anibal Ariza-Gutiérrez, Jacobo Berrio, Natalia Cantillo Torres, Maria Valeria Chamorro-Rodríguez, Lucia Conde, Oscar Hernando Feo Lee, María Camila González Nieto, Laura Cecilia Ibañez-Pintor, Catalina Ochoa, Juan Ospina
Format:	Journal Article
Language:	English
Published:	Elsevier 01-10-2024
Subjects:	Global health Health policy Hospital mortality Public health Surgery
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.
ISSN:	2667-193X