Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery - a prospective cohort study.

Autor:	Pérez Rivera CJ; Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia., Lozano-Suárez N; Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia.; Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia., Velandia-Sánchez A; Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia.; Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia., Vargas-Cuellar MP; Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia., Rojas-Serrano LF; Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia., Polanía-Sandoval CA; Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia.; Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia., Lara-Espinosa D; Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia., García-Zambrano L; Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia.; Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia., Bohórquez-Tarazona MP; Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia., Agudelo-Mendoza SV; Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia., Cabrera-Rivera PA; Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia., Briceno-Ayala L; Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia.
Jazyk:	angličtina
Zdroj:	Lancet regional health. Americas [Lancet Reg Health Am] 2024 Aug 20; Vol. 38, pp. 100862. Date of Electronic Publication: 2024 Aug 20 (Print Publication: 2024).
DOI:	10.1016/j.lana.2024.100862
Abstrakt:	Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32-64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien-Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68-12.76) and any complication (31.6%, 30.09-33.07). POMR stood at 1.9% (1.48-2.37), with elective and emergency surgery mortalities at 0.7% (0.40-1.23) and 3% (2.3-3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low-risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017. Competing Interests: All authors declare there are no conflicts of interest. (© 2024 The Author(s).)
Databáze:	MEDLINE
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