Surgery outcomes suffer in poorer countries

Patients undergoing emergency surgery in lower income countries have a three times greater chance of dying than in higher income countries, new research shows.

The study demonstrates a need to improve patient safety in low income countries, and revisit the use of the surgical safety checklists - the standard global marker of hospital safety, researchers say.

Deaths after surgery

Scientists from the Universities of Edinburgh, Birmingham and Sheffield monitored post-surgery death rates and mapped them against the Human Development Index (HDI) of each country.

10,745 patients were monitored up to 30 days after undergoing emergency abdominal surgery, at hospitals in 58 participating countries.

The study showed that death rates were three times higher in low income countries than in high income countries, even after adjustment for factors such as fitness for surgery, diabetes history and smoking status.

The findings have been published in the British Journal of Surgery.

Access to safe care

It is believed that less than a third of the world's population have access to safe, timely and affordable surgery.

Only 6 per cent of the 300 million surgical procedures performed each year take place in low or middle income countries, despite a third of the world's population living there.

Surgical death rates are routinely collected in high income countries, such as the United Kingdom and United States, but there is little to no surveillance in as many as 70 per cent of low and middle income countries.

Mr Ewen Harrison, from the University's Department of Clinical Surgery, described the importance of collecting this data in order to understand what influences surgical outcomes.

He said: "Improving surgical access and safety can only be achieved if we really understand what influences surgical outcomes on a global scale".

Global study

The team behind the research have developed a novel model of data collection, forming an international collaboration of doctors known as 'GlobalSurg'.

This network was created largely using social media, and data capture during the study was improved by use of a novel platform accessible from mobile internet devices.

Dr Edward Fitzgerald, from the GlobalSurg committee, added: "By creating an international network of surgeons it has been possible to collect data on real patients, at the bedside. "

The team also analysed the types of surgery being conducted. Regardless of income setting, the most commonly performed emergency abdominal operation was removal of appendix.

The GlobalSurg team hopes that their ongoing research will build on the findings and look to identify targets to help improve the safety of operations for surgical patients around the world.

Related Links

GlobalSurg project

Mr Ewen Harrison profile