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Global burden of postoperative death

2019; Elsevier BV; Volume: 393; Issue: 10170 Linguagem: Inglês

10.1016/s0140-6736(18)33139-8

1474-547X

Dmitri Nepogodiev, Janet Martin, Bruce Biccard, Alex Makupe, Aneel Bhangu, Dmitri Nepogodiev, Janet Martin, Bruce Biccard, Alex Makupe, Adesoji Ademuyiwa, Adewale Adisa, Maria-Lorena Aguilera, Sohini Chakrabortee, J.E.F. Fitzgerald, Dhruva Ghosh, James Glasbey, Ewen M. Harrison, JC Allen Ingabire, Hosni Salem, Marie Carmela Lapitan, Ismaïl Lawani, D. Lissauer, Laura Magill, Rachel Moore, Daniel Osei‐Bordom, Thomas Pinkney, Ahmad Uzair Qureshi, Antonio Ramos‐De la Medina, Sarah Rayne, Sudha Sundar, Stephen Tabiri, Azmina Verjee, Raul Yepez, O. James Garden, Richard Lilford, Peter Brocklehurst, Dion Morton, Aneel Bhangu,

Global Health Workforce Issues

The Lancet Commission on Global Surgery1Meara JG Leather AJ Hagander L et al.Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development.Lancet. 2015; 386: 569-624Summary Full Text Full Text PDF PubMed Scopus (1818) Google Scholar identified that 313 million surgical procedures are performed worldwide each year. Little is known about the quality of surgery globally because robust reports of postoperative death rates are available for only 29 countries.2Marks IH Kamali P Khan MA et al.Data for the sustainable development of surgical systems: a global collaboration.http://docs.wixstatic.com/ugd/346076_c853bd6c09d34ed6bca4b9b622d69de3.pdfDate: 2016Date accessed: June 20, 2018Google Scholar The rate of postoperative deaths is a measure of the success of surgical care systems, and improving this metric is a global priority. We aimed to estimate, on the basis of surgical volume, case mix, and postoperative death rates adjusted for country-income level, how many people around the world die within 30 days of surgery. England's combined Hospital Episode Statistics and Office of National Statistics (HES-ONS) dataset is one of the world's most comprehensive procedure-specific resources on mortality, reporting national coverage from a universal health-care system. We used the HES-ONS dataset as the baseline for our estimations for high-income settings and adjusted case-mix and mortality in HES-ONS to estimate total postoperative deaths in low-income and middle-income countries (LMICs). We estimated probable additional postoperative deaths if surgical volume were expanded to address the annual unmet need for 143 million surgical procedures in LMICs (appendix).3Rose J Weiser TG Hider P Wilson L Gruen RL Bickler SW Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate.Lancet Glob Health. 2015; 3: S13-S20Summary Full Text Full Text PDF PubMed Scopus (220) Google Scholar Our analysis suggests that at least 4·2 million people worldwide die within 30 days of surgery each year, and half of these deaths occur in LMICs. This number of postoperative deaths accounts for 7·7% of all deaths globally,4GBD 2016 Causes of Death CollaboratorsGlobal, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet. 2017; 390: 1151-1210Summary Full Text Full Text PDF PubMed Scopus (2927) Google Scholar making it the third greatest contributor to deaths, after ischaemic heart disease and stroke (figure). More people die within 30 days of surgery annually than from all causes related to HIV, malaria, and tuberculosis combined (2·97 million deaths).4GBD 2016 Causes of Death CollaboratorsGlobal, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet. 2017; 390: 1151-1210Summary Full Text Full Text PDF PubMed Scopus (2927) Google Scholar We project that an expansion of surgical services to address unmet need would increase total global deaths to 6·1 million annually, of which 1·9 million deaths would be in LMICs. Our analytical approach is limited by several necessary assumptions (appendix). For example, HES-ONS reports some of the lowest postoperative death rates in the world. Basing our calculation on postoperative death rates with higher baselines than other high-income countries substantially increases our projections of total postoperative deaths. Although there is a pressing need to expand surgical services to populations that are underserved, this expansion must be done in tandem with initiatives to reduce postoperative deaths. Funders and policy makers should prioritise research that aims to make surgery safer, particularly in LMICs. Routine measurement of surgical outcomes is essential to monitoring global progress in addressing the burden of postoperative deaths. We declare no competing interests. DN and AB conducted the data analysis and interpretation and had access to all data. DN, JM, BB, AM, and AB drafted the manuscript. Collaborators listed in the appendix revised the manuscript, approved the final draft, and approved the decision to submit the manuscript. AB is the guarantor for this report. This Correspondence was funded by a National Institute for Health Research (NIHR) Global Health Research Unit Grant (NIHR 17–0799). The funder had no role in the study design, data collection, analysis, interpretation, or the writing of this Correspondence. The funder has approved the submission of this Correspondence for publication. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health and Social Care. Download .pdf (.41 MB) Help with pdf files Supplementary appendix Making all deaths after surgery countWe read with interest the estimated global postoperative death rates by by Dmitri Nepogodiev and colleagues.1 The authors highlighted the importance of routinely measuring surgical outcomes and expanding surgical services, together with initiatives to reduce postoperative death. Additionally, permanent disability should be considered when addressing the burden of surgical procedures. Permanent disability is particularly relevant with regard to neurosurgery, in which postoperative neurological changes could have important consequences in the patient's daily life. Full-Text PDF Making all deaths after surgery countWe welcome the important focus that Dmitri Nepogodiev and colleagues1 bring to surgical safety. The authors estimate that globally, postoperative deaths account for 4·2 million deaths per year (7·7% of total deaths). Nepogodiev and colleagues project an expansion of surgical services in low-income and middle-income countries (LMICs) will result in an additional 1·9 million postoperative deaths per year, assuming that the postoperative mortality rate in LMICs remains constant while surgical services in these countries expand. Full-Text PDF Making all deaths after surgery count – Authors' replySafe surgery saves lives and is a cost-effective public health intervention, but it is associated with risks.1 We estimated that, worldwide, more people die within 30 days of surgery than of any disease-specific category of death, with the exception of stroke and ischaemic heart disease.2 Globally, disparities in postoperative death exist, with the majority of deaths occurring in low-income and middle-income countries (LMICs), despite only a minority of global surgeries being done there. High postoperative mortality rates indicate system failures, which are prevalent in LMICs. Full-Text PDF Making all deaths after surgery countPostoperative death is not unheard of, yet patients hope that such an outcome is unlikely when they require surgery themselves. Dmitri Nepogodiev and colleagues1 estimate that, globally, at least 4·2 million people die each year within 30 days of a surgical procedure—a cause of death known as perioperative mortality, which was a focus of the Lancet Commission on Global Surgery.2 Nepogodiev and colleagues used a complex model for perioperative mortality in different economic regions, making numerous assumptions and calculations since little data on perioperative mortality exists in any setting. Full-Text PDF