Publications Scientifiques

[ Article ] Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Date de soumission: 08-01-2017
Année de Publication: 2016
Entité/Laboratoire Unité Médicale d'Accueil des Urgences (UMAU)
Document type : Article
Discipline(s) : Chirurgie
Titre Mortality of emergency abdominal surgery in high-, middle- and low-income countries
Auteurs GlobalSurg Collaborative et al [1], ASSOUTO ASSOGBA PAMPHILE [1], Lawani ismail [1], IMOROU S. YACOUBOU [1],
Journal: British Journal of Surgery
Catégorie Journal: Internationale
Impact factor: 5.596
Volume Journal: 103
DOI: doi: 10.1002/bjs.10151.
Resume Background Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1·6 per cent at 24 h (high 1·1 per cent, middle 1·9 per cent, low 3·4 per cent; P < 0·001), increasing to 5·4 per cent by 30 days (high 4·5 per cent, middle 6·0 per cent, low 8·6 per cent; P < 0·001). Of the 578 patients who died, 404 (69·9 per cent) did so between 24 h and 30 days following surgery (high 74·2 per cent, middle 68·8 per cent, low 60·5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2·78, 95 per cent c.i. 1·84 to 4·20) and low-income (OR 2·97, 1·84 to 4·81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov).
Mots clés Mortality, emergency abdominal surgery, high-, middle- and low-income countries
Pages 971 - 988
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