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dc.contributor.authorMartin, Daniel
dc.date.accessioned2020-07-09T13:40:56Z
dc.date.available2020-07-09T13:40:56Z
dc.date.issued2016-11
dc.identifier.issn0007-0912
dc.identifier.issn1471-6771
dc.identifier.urihttp://hdl.handle.net/10026.1/15943
dc.description.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

dc.format.extent601-609
dc.format.mediumPrint
dc.languageen
dc.language.isoen
dc.publisherElsevier BV
dc.subjectcohort studies
dc.subjectcritical care/utilisation
dc.subjectoperative/mortality
dc.subjectpostoperative care/methods
dc.subjectpostoperative care/statistics and numerical data
dc.subjectsurgery
dc.subjectsurgical procedures
dc.titleGlobal patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries
dc.typejournal-article
dc.typeJournal Article
dc.typeMulticenter Study
plymouth.author-urlhttps://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000430670900001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=11bb513d99f797142bcfeffcc58ea008
plymouth.issue5
plymouth.volume117
plymouth.publication-statusPublished
plymouth.journalBritish Journal of Anaesthesia
dc.identifier.doi10.1093/bja/aew316
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/Peninsula Medical School
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA01 Clinical Medicine
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
dc.publisher.placeEngland
dcterms.dateAccepted2016-08-08
dc.identifier.eissn1471-6771
dc.rights.embargoperiodNot known
rioxxterms.versionofrecord10.1093/bja/aew316
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2016-11
rioxxterms.typeJournal Article/Review


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