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

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. Study registration: ISRCTN51817007

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2)

“…Median LOS was shorter in the ERAS group compared with the non-ERAS group (4 [IQR,(3)(4)(5) vs 5 [IQR,[4][5][6] days; P < .001). Regarding the difference by adherence quartiles, quartile 1 presented with a median LOS of 5 (IQR,(4)(5)(6) days, compared with 4 (IQR, [3][4][5] days in the highest adherence group (OR, 0.97; 95% CI, 0.96-0.99; P < .001) (Figure 3).…”

“…Median LOS was shorter in the ERAS group compared with the non-ERAS group (4 [IQR,(3)(4)(5) vs 5 [IQR,[4][5][6] days; P < .001). Regarding the difference by adherence quartiles, quartile 1 presented with a median LOS of 5 (IQR,(4)(5)(6) days, compared with 4 (IQR, [3][4][5] days in the highest adherence group (OR, 0.97; 95% CI, 0.96-0.99; P < .001) (Figure 3). The post hoc multivariable analysis of the influence of patient characteristics and ERAS items showed a statistically significant reduction of LOS in patients who achieved early mobilization (β coefficient, −0.51; 95% CI, −0.95 to −0.06; P = .03) and received local anesthesia (β coefficient, −1.59; 95% CI, −2.61 to −0.57; P = .002), whereas active prevention of unintentional hypothermia (β coefficient, 0.78; 95% CI, 0.30-1.26; P = .001), epidural anesthesia (β coefficient, 1.53; 95% CI, 0.79-2.26; P < .001), and complications (β coefficient, 2.63; 95% CI, 2.00-3.25; P < .001) were associated with an increase in LOS (eTable 13 in the Supplement).…”

“…Stratification of adherence to individual ERAS items by severity groups showed that healthier patients had higher adherence to ERAS (eTable 12 in the Supplement). In the ERAS centers, patients with ASA scores of I to II experienced less infection of uncertain source (1 [0.1%] vs 16 [0.5%]; OR, 0.19; 95% CI, 0.01-0.91; P = .04), less hemorrhage (18 [0.1%] vs 104 [3.2%]; OR, 0.45; 95% CI, 0.26-0.73; P = .001), and lower median LOS [3][4][5] vs 5 [IQR,[4][5][6] days; OR, 0.97; 95% CI, 0.95-0.98; P < .001) compared with those with less adherence to ERAS (eFigure 9 in the Supplement), whereas no difference was found between patients with ASA scores of III to IV with more or less adherence to ERAS (eFigure 10 in the Supplement).…”

“…eTables 4 and 5 in the Supplement show the stratified complications in THA and TKA in ERAS vs non-ERAS centers. In THA and TKA, the ERAS group had shorter median LOS(THA, 4 [IQR,(3)(4)(5) vs 5[IQR,[4][5][6] days; TKA, 4 [IQR,[3][4][5] vs 5[IQR,[4][5][6] days) (eFigure 1 and eTables 4 and 5 in the Supplement). Graduation of the severity of postoperative complications is shown in eTable 6 of the Supplement.ERAS Adherence and Outcome Data…”

Dynamics of the baroreflex sensitivity during combined anesthesia with sevoflurane or propofol: a randomized trial

“…Нес мотря на большое внимание, уделяемое повышению качества анестезии в абдоминальной хирургии, значительное число осложнений все еще является серьезной проблемой, и неко торые из них существенно влияют на лечение и могут приводить к неб лагоприятному исходу [1]. Среди специфических осложнений анестезии выделяют острые нарушения системной гемодинамики, гипотермию, метаболические нарушения.…”