Surgical Outcomes Roughly Equal in Poor and Rich Countries

Approximately 310 million patients undergo elective surgery worldwide each year. How do those surgeries turn out? Until now, little data has been collected about the complications that have followed all of those surgeries. A new study from Queen Mary University, London, provides a set of comparative surgical statistics at an international level. The story was first published in the British Journal of Anaesthesia and reported in Medical Press.

A major finding of the study is that while unfavorable patient outcomes are common after elective surgery, mortality rates following complications were at broadly similar levels in the hospitals in the poorest and wealthiest countries.

The lead author of the study, Professor Rupert Pearse, said of the results: “This survey is the most extensive of its kind ever performed. Whilst most patients having planned surgery did not experience any problems, a large number of patients did develop complications and many of them did not survive.”

In 27 high-, middle- and low- income countries, 475 hospitals participated in the study over a seven day period. Researchers analyzed data from 44, 814 patients following their routine, non-emergency surgery. The study compared different types of surgery with the frequency of adverse outcomes, and quantified the range of complications occurring and their severity.

The survey found that one in six patients (16.8%) developed complications in the hospital, and that one in 35 of those patients (2.8%) subsequently died without ever leaving the hospital. The figures based on a seven day sample period suggest that over a 12 month period, 50 million patients suffer complications following surgery in hospitals, and that over 1.5 million of them die from those complications.

The most common complication following surgery was superficial site infection, caused by bacteria on the skin in and around the surgical wound. The study found that 2.9% of patients suffered from such infections, which equates to nine million patients worldwide, every year. Of those patients, 1.3% died from the infection (117, 000 patients annually).

The total number of patients affected by all types of infectious complications was 9% which would be 28 million patients annually. Cardiovascular complications affected 4.5% of all patients.

The survey found that fewer patients suffered complications following surgery in hospitals in low and middle income countries—11% of patients compared to 19% in high income countries. The researchers suggested that this may be because surgery is offered to patients in high income countries who are older, frailer, suffering from long-term diseases, such as diabetes or heart failure, and who are therefore at greater risk.

The type of surgery which carried the greatest risk of complications worldwide was upper gastrointestinal—surgery involving the esophagus, stomach and small bowel. The surgery carrying the greatest risk of mortality following a complication was cardiac procedures. The procedures carrying the least risk of complications were related to orthopedics and breast procedures.

Countries included in the study were: high income—Australia, Austria, Belgium, Canada, Denmark, France, Germany, Greece, Hong Kong, Italy, The Netherlands, New Zealand, Portugal, Russia, Spain, Sweden, Switzerland, UK, and U.S.; low and middle income—Brazil, China, Indonesia, Malaysia, Nigeria, South Africa, Romania and Uganda.