Global Patient Outcomes After Elective Surgery: Prospective Cohort Study in 27 Low-, Middle- and High-Income Countries
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.17/2960 |
Resumo: | 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. |
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Global Patient Outcomes After Elective Surgery: Prospective Cohort Study in 27 Low-, Middle- and High-Income CountriesHCC NEFCritical Care/utilizationElective Surgical Procedures/adverse effectsElective Surgical Procedures/mortalityGlobal Health/statistics & numerical dataHospital MortalityLength of Stay/statistics & numerical dataPostoperative Complications/epidemiologyPovertyProspective StudiesSocioeconomic FactorsTreatment OutcomeBACKGROUND: 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.ElsevierRepositório do Centro Hospitalar Universitário de Lisboa Central, EPENolasco, FInternational Surgical Outcomes Study Group.2018-03-15T16:27:22Z20162016-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/2960engBr J Anaesth. 2016 Oct 31;117(5):601-60910.1093/bja/aew316info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:40:31Zoai:repositorio.chlc.min-saude.pt:10400.17/2960Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:20:16.790639Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Global Patient Outcomes After Elective Surgery: Prospective Cohort Study in 27 Low-, Middle- and High-Income Countries |
title |
Global Patient Outcomes After Elective Surgery: Prospective Cohort Study in 27 Low-, Middle- and High-Income Countries |
spellingShingle |
Global Patient Outcomes After Elective Surgery: Prospective Cohort Study in 27 Low-, Middle- and High-Income Countries Nolasco, F HCC NEF Critical Care/utilization Elective Surgical Procedures/adverse effects Elective Surgical Procedures/mortality Global Health/statistics & numerical data Hospital Mortality Length of Stay/statistics & numerical data Postoperative Complications/epidemiology Poverty Prospective Studies Socioeconomic Factors Treatment Outcome |
title_short |
Global Patient Outcomes After Elective Surgery: Prospective Cohort Study in 27 Low-, Middle- and High-Income Countries |
title_full |
Global Patient Outcomes After Elective Surgery: Prospective Cohort Study in 27 Low-, Middle- and High-Income Countries |
title_fullStr |
Global Patient Outcomes After Elective Surgery: Prospective Cohort Study in 27 Low-, Middle- and High-Income Countries |
title_full_unstemmed |
Global Patient Outcomes After Elective Surgery: Prospective Cohort Study in 27 Low-, Middle- and High-Income Countries |
title_sort |
Global Patient Outcomes After Elective Surgery: Prospective Cohort Study in 27 Low-, Middle- and High-Income Countries |
author |
Nolasco, F |
author_facet |
Nolasco, F International Surgical Outcomes Study Group. |
author_role |
author |
author2 |
International Surgical Outcomes Study Group. |
author2_role |
author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Nolasco, F International Surgical Outcomes Study Group. |
dc.subject.por.fl_str_mv |
HCC NEF Critical Care/utilization Elective Surgical Procedures/adverse effects Elective Surgical Procedures/mortality Global Health/statistics & numerical data Hospital Mortality Length of Stay/statistics & numerical data Postoperative Complications/epidemiology Poverty Prospective Studies Socioeconomic Factors Treatment Outcome |
topic |
HCC NEF Critical Care/utilization Elective Surgical Procedures/adverse effects Elective Surgical Procedures/mortality Global Health/statistics & numerical data Hospital Mortality Length of Stay/statistics & numerical data Postoperative Complications/epidemiology Poverty Prospective Studies Socioeconomic Factors Treatment Outcome |
description |
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. |
publishDate |
2016 |
dc.date.none.fl_str_mv |
2016 2016-01-01T00:00:00Z 2018-03-15T16:27:22Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/2960 |
url |
http://hdl.handle.net/10400.17/2960 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Br J Anaesth. 2016 Oct 31;117(5):601-609 10.1093/bja/aew316 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Elsevier |
publisher.none.fl_str_mv |
Elsevier |
dc.source.none.fl_str_mv |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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