Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries The International Surgical Outcomes Study group

被引：181

作者：

Ahmad, T. ^{[1
]}

Bouwman, R. A. ^{[2
]}

Grigoras, I. ^{[3
]}

Aldecoa, C. ^{[4
]}

Hofer, C. ^{[5
]}

Hoeft, A. ^{[6
]}

Holt, P. ^{[7
]}

Fleisher, L. A. ^{[8
]}

Buhre, W. ^{[9
]}

Pearse, R. M. ^{[10
]}

Ferguson, Marissa ^{[11
]}

MacMahon, Michael ^{[11
]}

Shulman, Mark ^{[11
]}

Cherian, Ritchie ^{[12
]}

Currow, Helen ^{[12
,15
]}

Kanathiban, Kathirgamanathan ^{[12
]}

Gillespie, David ^{[13
]}

Pathmanathan, Edward ^{[13
]}

Phillips, Katherine ^{[13
]}

Reynolds, Jenifer ^{[13
]}

Rowley, Joanne ^{[13
]}

Douglas, Jeanene ^{[14
]}

Kerridge, Ross ^{[14
]}

Garg, Sameer ^{[15
]}

Bennett, Michael ^{[16
]}

Jain, Megha ^{[16
]}

Alcock, David ^{[17
,35
]}

Terblanche, Nico ^{[17
]}

Cotter, Rochelle ^{[18
]}

Leslie, Kate ^{[18
]}

Stewart, Marcelle ^{[18
]}

Zingerle, Nicolette ^{[18
]}

Clyde, Antony ^{[19
]}

Hambidge, Oliver ^{[19
]}

Rehak, Adam ^{[19
]}

Cotterell, Sharon ^{[20
]}

Huynh, Wilson Binh Quan ^{[20
]}

McCulloch, Timothy ^{[20
]}

Ben-Menachem, Erez ^{[21
]}

Egan, Thomas ^{[21
]}

Cope, Jennifer ^{[22
]}

Halliwell, Richard ^{[22
]}

Fellinger, Paul ^{[23
]}

Haisjackl, Markus ^{[23
]}

Haselberger, Simone ^{[23
]}

Holaubek, Caroline ^{[23
]}

Lichtenegger, Paul ^{[23
]}

Scherz, Florian ^{[23
]}

Schmid, Werner ^{[23
]}

Hoffer, Franz ^{[24
]}

机构：

[1] Queen Mary Univ London, London EC1M 6BQ, England

[2] Catharina Hosp, Eindhoven, Netherlands

[3] Grigore T Popa Univ Med & Pharm, Reg Inst Oncol, Iasi, Romania

[4] Hosp Univ Rio Hortega, Valladolid, Spain

[5] Triemli City Hosp, Zurich, Switzerland

[6] Univ Hosp Bonn, D-53105 Bonn, Germany

[7] St Georges Univ London, London SW17 0RE, England

[8] Univ Penn, Philadelphia, PA 19104 USA

[9] Maastricht Univ, Med Ctr, Maastricht, Netherlands

[10] Queen Mary Univ London, Barts & London Sch Med & Dent, London EC1M 6BQ, England

[11] Alfred Hosp, Melbourne, Vic, Australia

[12] Blacktown Hosp, Blacktown, NSW, Australia

[13] Coffs Harbour Base Hosp, Coffs Harbour, NSW, Australia

[14] John Hunter Hosp, Newcastle, NSW, Australia

[15] Mount Druitt Hosp, Blacktown, NSW, Australia

[16] Prince Wales Hosp, Randwick, NSW, Australia

[17] Royal Hobart Hosp, Hobart, Tas, Australia

[18] Royal Melbourne Hosp, Melbourne, Vic, Australia

[19] Royal North Shore Hosp, St Leonards, NSW, Australia

[20] Royal Prince Alfred Hosp, Sydney, NSW, Australia

[21] St Vincents Hosp, Melbourne, Vic, Australia

[22] Westmead Hosp, Westmead, NSW, Australia

[23] Allgemeines Krankenhaus Wien, Vienna, Austria

[24] Landesklinikum Hollabrunn, Hollabrun, Austria

[25] Landesklinikum Horn, Horn, Austria

[26] Landesklinikum Krems, Krems, Austria

[27] Landesklinikum Neunkirchen, Neunkirchen, Austria

[28] Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria

[29] Landesklinikum Zwettl, Zwettl, Austria

[30] Landeskrankenhaus Feldkirch, Feldki, Austria

[31] Landeskrankenhaus Villach, Villach, Austria

[32] Salzburger Landeskliniken, Salzburg, Austria

[33] Ctr Hosp Reg Namur, Namur, Belgium

[34] Ctr Hosp Univ Brugmann, Brussels, Belgium

[35] Clin Univ St Luc, Brussels, Belgium

[36] Heilig Hart Ziekenhuis Roeselaere, Roeselare, Belgium

[37] Onze Lieve Vrouw Ziekenhuis Aalst, Aalst, Belgium

[38] Univ Ziekenhuis Antwerpen, Antwerp, Belgium

[39] Univ Ziekenhuis Brussel, Brussels, Belgium

[40] Univ Ziekenhuis Gent, Ghent, Belgium

[41] Univ Ziekenhuis Leuven, Leuven, Belgium

[42] Ziekenhuis Oost Limburg Campus St Jan Genk, Genk, Belgium

[43] Hosp Base Sao Jose Rio Preto SP, Fac Med, Sao Jose Do Rio Preto, SP, Brazil

[44] Univ Sao Paulo, Hosp Clin, Fac Med, BR-05508 Sao Paulo, Brazil

[45] Hosp Clin, Fac Med Botucatu, Botucatu, SP, Brazil

[46] Hosp Canc Barretos Fundacao PIO 12, Barretos, Brazil

[47] Hosp Serv Publ Estadual Sao Paulo, Sao Paulo, Brazil

[48] Hosp Trabalhador, Curitiba, Parana, Brazil

[49] Hosp Pompeia Caxias Sul, Caxias Do Sul, RS, Brazil

[50] Hosp Sao Lucas, Porto Alegre, RS, Brazil

来源：

BRITISH JOURNAL OF ANAESTHESIA | 2016年 / 117卷 / 05期

关键词：

cohort studies; critical care/utilisation; operative/mortality; postoperative care/methods; postoperative care/statistics and numerical data; surgery; surgical procedures;

D O I：

10.1093/bja/aew316

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

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 amedian 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.

引用

页码：601 / +

页数：26

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