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：217

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

共 12 条

[1] Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery
Ahmad, T.
Bouwman, R. A.
Grigoras, I.
Aldecoa, C.
Hofer, C.
Hoeft, A.
Holt, P.
Fleisher, L. A.
Buhre, W.
Pearse, R. M.
Ferguson, Marissa
MacMahon, Michael
Shulman, Mark
Cherian, Ritchie
Currow, Helen
Kanathiban, Kathirgamanathan
Gillespie, David
Pathmanathan, Edward
Phillips, Katherine
Reynolds, Jenifer
Rowley, Joanne
Douglas, Jeanene
Kerridge, Ross
Garg, Sameer
Bennett, Michael
Jain, Megha
Alcock, David
Terblanche, Nico
Cotter, Rochelle
Leslie, Kate
Stewart, Marcelle
Zingerle, Nicolette
Clyde, Antony
Hambidge, Oliver
Rehak, Adam
Cotterell, Sharon
Huynh, Wilson Binh Quan
McCulloch, Timothy
Ben-Menachem, Erez
Egan, Thomas
Cope, Jennifer
Halliwell, Richard
Fellinger, Paul
Haisjackl, Markus
Haselberger, Simone
Holaubek, Caroline
Lichtenegger, Paul
Scherz, Florian
Schmid, Werner
Hoffer, Franz
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