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Ghanem, Esraa/0000-0001-5494-2974; Maffioli, Anna/0000-0001-7116-4019; Ansaloni, Luca/0000-0001-6427-0307; Roslani, April Camilla/0000-0003-2458-965X; Merlini, David A/0000-0002-7981-7149; Elfeki, Hossam/0000-0003-0704-4068; Lund, Jonathan/0000-0001-5195-2181; Mikalauskas, Saulius/0000-0002-5191-1491; Mentula, Panu/0000-0002-6516-3797; Barneo, Luis/0000-0001-9410-4262; Gharib, Abdalla A/0000-0001-7157-5950; Fahmy, Mohamed A Baky/0000-0002-3570-1742; Rabie, Mohamed A/0000-0001-7799-2931; Aber, Ahmed/0000-0002-5707-2430; Vimalachandran, Dale/0000-0001-5817-8969; Shaikh, Shafaque/0000-0002-4536-9595; Fahmy, Mohamed/0000-0002-3570-1742; Beuran, Mircea/0000-0002-0889-1675; Glasbey, James/0000-0001-7688-5018; ALI, EMAD ALI AHMED/0000-0003-4384-0934; Loughran, Dafydd/0000-0002-2708-7092; Cirocchi, Roberto/0000-0002-2457-0636; Negida, Ahmed/0000-0001-5363-6369; Iordache, Florin/0000-0001-7108-7279; Furqan, Muhammad Mohsin/0000-0003-0719-5069; Kennedy, Ewan D/0000-0002-0115-4488; Boddy, Alexander P/0000-0001-7243-0155; Wong, Chee Siong/0000-0003-4818-5609; Peycelon, Matthieu/0000-0003-3617-4849; Di Saverio, Salomone/0000-0001-5685-5022; Chapman, Stephen J/0000-0003-2413-5690; Nepogodiev, Dmitri/0000-0002-2171-2862; Mironescu, Aurel/0000-0003-1827-6948; Smart, Neil/0000-0002-3043-8324; Nouh, Thamer/0000-0002-7118-7453; Samaraweera, Dulan/0000-0001-8334-8157; Coccolini, Federico/0000-0001-6364-4186; Poskus, Tomas/0000-0002-6931-6041; Mihanovic, Jakov/0000-0001-6450-2956; Labib, Peter LZ/0000-0003-2362-9218; Zalabia, Mohamed Fadel/0000-0003-2372-2914; Antar, Sarah/0000-0001-6091-2835; Soreide, Kjetil/0000-0001-7594-4354; morsi, mahmoud/0000-0001-6825-7361; Gemeah, Mostafa/0000-0002-9145-9348; Pata, Francesco/0000-0003-2634-1199; Ozkan, Bahar Busra/0000-0002-0939-8049; Boshnaq, Mohamed/0000-0002-7333-4509; Tham, Ji Chung/0000-0003-1796-9347; Daniels, Ian/0000-0002-9114-0812; van Duren, Bernard/0000-0003-1877-8227; Romani, Diego/0000-0003-2844-5282; Giuliani, Stefano/0000-0002-4555-3093; Thorell, Anders/0000-0001-7238-1728; Tilston, Thomas/0000-0002-4484-1771; Gouvas, Nikolaos/0000-0002-6541-4226; Schmitt, Francoise/0000-0002-3863-7694; Camilleri-Brennan, John/0000-0003-0241-8913; Allam, Moustafa/0000-0003-1034-6278; O'Neill, Stephen/0000-0002-3252-340X; McGuigan, Andrew/0000-0002-5097-5063; Shehata, Sherif/0000-0002-9733-006X; Abbo, Olivier/0000-0002-4202-4284; Torrance, Hew David/0000-0002-3854-1748; Wilson, Michael/0000-0003-1083-4466; Jaffry, Zahra/0000-0003-4101-2246; Elgebaly, Ahmed/0000-0002-8324-0960; Sgroi, Giovanni/0000-0003-4956-124X; El-Sheemy, Hatem/0000-0003-1667-2672; Abdelmotaleb Ghazy, Ahmed Azmy/0000-0002-9145-7115; Lim, Shujing Jane/0000-0003-4970-7405; Stoddart, Michael/0000-0001-7346-324X; Moore, Rachel/0000-0003-1404-8673; Machain V, Gustavo Miguel/0000-0001-9848-1575; Amandito, Radhian/0000-0002-1211-7973; Arman, Sam/0000-0001-9620-5171; SHAWKI, Marwan/0000-0001-6053-5523; Pata, Giacomo/0000-0001-7867-9349; Salma, Mahmoud/0000-0002-8964-5619; Rahman Mitul, Ashrarur/0000-0002-7100-7723; Hanrahan, Michael/0000-0002-2358-5975; Lopez, Crislee/0000-0002-8775-3675; Mohan, Midhun/0000-0002-1865-8623; Fitzgerald, James/0000-0002-4453-5117; Hammad, Ali/0000-0003-1894-3480; Morsi, Mahmoud/0000-0002-6621-0751; afifi, ahmed/0000-0002-4294-8217; Marshall, Dominic/0000-0002-3498-2511; Manrique Sila, George Christian/0000-0001-7660-6701; Tanase, Andrei/0000-0001-9465-8302; Todd, Oliver/0000-0001-7212-8095; senanayake, kithsiri/0000-0002-1324-9126; ZANI, AUGUSTO/0000-0003-2283-9846; Griffiths, Ewen/0000-0001-6630-3547; Anwer, Abdul Wahid/0000-0001-8737-4846; Ahmed, Hussien/0000-0001-7101-837X; Etchill, Eric/0000-0002-5381-648X; Wright, Naomi/0000-0003-4105-8009; Holmer, Hampus/0000-0003-3745-7402; Alhendy, Mohammed/0000-0003-3434-1156; Al-Obaedi, Ossama/0000-0002-3658-3119; Germanos, Stylianos/0000-0002-1640-1226; Hassanain, Mazen/0000-0002-2441-5142; Hassan, Mariam/0000-0001-6160-9723; Ramos-De la Medina, Antonio/0000-0002-7321-1410; Warren, Oliver/0000-0001-8948-7473; Mohammed, Mohammed Mustafa Hassan/0000-0003-3013-1792; Turati, Luca/0000-0002-6958-6682; Scalabre, Aurelien/0000-0001-7361-1900; Bondurri, Andrea/0000-0002-6521-5876; LAWANI, Ismail/0000-0001-5022-6313; FAURE, alice/0000-0002-3327-6391; Khatri, Chetan/0000-0002-3961-1314; Davenport, Ross/0000-0002-8593-6582 WOS: 000380175500006 PubMed: 27145169 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). Medical Research CouncilMedical Research Council UK (MRC) [MR/N029984/1] |
