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Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

Title: Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.
Authors: Ahmad, T
Bouwman, RA
Grigoras, I
Aldecoa, C
Hofer, C
Hoeft, A
Holt, P
Fleisher, LA
Buhre, W
Pearse, RM
Ferguson, M
MacMahon, M
Shulman, M
Cherian, R
Currow, H
Kanathiban, K
Gillespie, D
Pathmanathan, E
Phillips, K
Reynolds, J
Rowley, J
Douglas, J
Kerridge, R
Garg, S
Bennett, M
Jain, M
Alcock, D
Terblanche, N
Cotter, R
Leslie, K
Stewart, M
Zingerle, N
Clyde, A
Hambidge, O
Rehak, A
Cotterell, S
Huynh, WBQ
McCulloch, T
Ben-Menachem, E
Egan, T
Cope, J
Halliwell, R
Fellinger, P
Haisjackl, M
Haselberger, S
Holaubek, C
Lichtenegger, P
Scherz, F
Schmid, W
Hoffer, F
Cakova, V
Eichwalder, A
Fischbach, N
Klug, R
Schneider, E
Vesely, M
Wickenhauser, R
Grubmueller, KG
Leitgeb, M
Lang, F
Toro, N
Bauer, M
Laengle, F
Haberl, C
Mayrhofer, T
Trybus, C
Buerkle, C
Forstner, K
Germann, R
Rinoesl, H
Schindler, E
Trampitsch, E
Bogner, G
Dankl, D
Duenser, M
Fritsch, G
Gradwohl-Matis, I
Hartmann, A
Hoelzenbein, T
Jaeger, T
Landauer, F
Lindl, G
Lux, M
Steindl, J
Stundner, O
Szabo, C
Bidgoli, J
Verdoodt, H
Forget, P
Kahn, D
Lois, F
Momeni, M
Pregardien, C
Pospiech, A
Steyaert, A
Veevaete, L
De Kegel, D
De Jongh, K
Foubert, L
Smitz, C
Vercauteren, M
Poelaert, J
Van Mossevelde, V
Abeloos, J
Bouchez, S
Coppens, M
De Baerdemaeker, L
Deblaere, I
De Bruyne, A
De Hert, S
Fonck, K
Heyse, B
Jacobs, T
Lapage, K
Moerman, A
Neckebroek, M
Parashchanka, A
Roels, N
Van Den Eynde, N
Vandenheuvel, M
Van Limmen, J
Vanluchene, A
Vanpeteghem, C
Wouters, P
Wyffels, P
Huygens, C
Vandenbempt, P
Van de Velde, M
Dylst, D
Janssen, B
Schreurs, E
Aleixo, FB
Candido, K
Batista, HD
Guimaraes, M
Guizeline, J
Hoffmann, J
Lobo, S
Marques Lobo, FR
Nascimento, V
Nishiyama, K
Pazetto, L
Souza, D
Rodrigues, RS
Vilela dos Santos, AM
Jardim, J
Sa Malbouisson, LM
Silva, J
Do Nascimento Junior, P
Baio, TH
Pereira de Castro, GI
Watanabe Oliveira, HR
Amendola, CP
Cardoso, G
Ortega, D
Brotto, AF
De Oliveira, MC
Rea-Neto, A
Dias, F
Travi, ME
Zerman, L
Azambuja, P
Knibel, MF
Martins, A
Almeida, W
Neder Neto, C
Tardelli, MA
Caser, E
Machado, M
Aguzzoli, C
Baldisserotto, S
Tabajara, FB
Bettega, F
Rodrigues Junior, LHC
De Gasperi, J
Faina, L
Nolasco, MF
Da Costa Fischer, BF
De Campos Ferreira, MF
Hartmann, C
Kliemann, M
Ribeiro, GLH
Fraga, JM
Netto, TM
Pozza, LV
Wendling, PR
Azevedo, C
Garcia, J
Lopes, M
Maia, B
Maselli, P
Melo, R
Mendes, W
Neves, M
Ney, J
Piras, C
Applewhaite, C
Carr, A
Chow, L
Duttchen, K
Foglia, J
Greene, M
Hinther, A
Houston, K
McCormick, TJ
Mikhayel, J
Montasser, S
Ragan, A
Suen, A
Woolsey, A
Yu, HC
Funk, D
Kowalski, S
Legaspi, R
McDonald, H
Siddiqui, F
Pridham, J
Rowe, B
Sampson, S
Thiessen, B
Zbitnew, G
Bernard, A
George, R
Jones, P
Moor, R
Siddiqui, N
Wolfer, A
Tran, D
Winch, D
Dobson, G
McCormick, T
Montasser, O
Hall, R
Baghirzada, L
Curley, G
Dai, SY
Hare, G
Lee, E
Shastri, U
Tsui, A
Yagnik, A
Alvares, D
Choi, S
Dwyer, H
Flores, K
McCartney, C
Somascanthan, P
Beattie, S
Carroll, J
Pazmino-Canizares, J
Wijeysundera, D
Ami, N
Chan, V
Perlas, A
Argue, R
Huang, Y
Lavis, K
Mayson, K
Cao, Y
Gao, H
Hu, T
Lv, J
Yang, J
Yang, Y
Zhong, Y
Zhou, J
Zou, X
He, M
Li, X
Luo, D
Wang, H
Yu, T
Chen, L
Wang, L
Cai, Y
Cao, Z
Li, Y
Lian, J
Sun, H
Wang, S
Wang, Z
Wang, K
Zhu, Y
Du, X
Fan, H
Fu, Y
Huang, L
Huang, Y
Hwan, H
Luo, H
Qu, P-S
Tao, F
Wang, Z
Wang, G
Wang, S
Zhang, Y
Zhang, X
Chen, C
Wang, W
Liu, Z
Fan, L
Tang, J
Chen, Y
Chen, Y
Han, Y
Huang, C
Liang, G
Shen, J
Wang, J
Yang, Q
Zhen, J
Zhou, H
Chen, J
Chen, Z
Li, X
Meng, B
Ye, H
Zhang, X
Bi, Y
Cao, J
Guo, F
Lin, H
Liu, Y
Lv, M
Shi, P
Song, X
Sun, C
Sun, Y
Wang, Y
Wang, S
Zhang, M
Chen, R
Hou, J
Leng, Y
Meng, Q-T
Qian, L
Shen, Z-Y
Xia, Z-Y
Xue, R
Zhang, Y
Zhao, B
Zhou, X-J
Chen, Q
Guo, H
Guo, Y
Qi, Y
Wang, Z
Wei, J
Zhang, W
Zheng, L
Bao, Q
Chen, Y
Chen, Y
Fei, Y
Hu, N
Hu, X
Lei, M
Li, X
Lv, X
Lv, J
Miao, F
Ouyang, L
Qian, L
Shen, C
Sun, Y
Wang, Y
Wang, D
Wu, C
Xu, L
Yuan, J
Zhang, L
Zhang, H
Zhang, Y
Zhao, J
Zhao, C
Zhao, L
Zheng, T
Zhou, D
Zhou, H
Zhou, C
Lu, K
Zhao, T
He, C
Chen, H
Chen, S
Cheng, B
He, J
Jin, L
Li, C
Li, H
Pan, Y
Shi, Y
Wen, XH
Wu, S
Xie, G
Zhang, K
Zhao, B
Lu, X
Chen, F
Liang, Q
Lin, X
Ling, Y
Liu, G
Tao, J
Yang, L
Zhou, J
Chen, F
Cheng, Z
Dai, H
Feng, Y
Hou, B
Gong, H
Hu, CH
Huang, H
Huang, J
Jiang, Z
Li, M
Lin, J
Liu, M
Liu, W
Liu, Z
Liu, Z
Luo, F
Ma, L
Min, J
Shi, X
Song, Z
Wan, X
Xiong, Y
Xu, L
Yang, S
Zhang, Q
Zhang, H
Zhang, H
Zhang, X
Zhao, L
Zhao, W
Zhao, W
Zhu, X
Bai, Y
Chen, L
Chen, S
Dai, Q
Geng, W
Han, K
He, X
Huang, L
Ji, B
Jia, D
Jin, S
Li, Q
Liang, D
Luo, S
Lwang, L
Mo, Y
Pan, Y
Qi, X
Qian, M
Qin, J
Ren, Y
Shi, Y
Wang, J
Wang, J
Wang, L
Xie, J
Yan, Y
Yao, Y
Zhang, M
Zhao, J
Zhuang, X
Ai, Y
Du, F
He, L
Huang, L
Li, Z
Li, H
Li, Y
Li, L
Meng, S
Yuan, Y
Zhang, E
Zhang, J
Zhao, S
Ji, Z
Pei, L
Wang, L
Chen, C
Dong, B
Li, J
Miao, Z
Mu, H
Qin, C
Su, L
Wen, Z
Xie, K
Yu, Y
Yuan, F
Hu, X
Zhang, Y
Xiao, W
Zhu, Z
Dai, Q
Fu, K
Hu, R
Hu, X
Huang, S
Li, Y
Liang, Y
Yu, S
Guo, Z
Jing, Y
Tang, N
Wu, J
Yuan, D
Zhang, R
Zhao, X
Li, Y
Bai, H-P
Liu, C-X
Liu, F-F
Ren, W
Wang, X-L
Xu, G-J
Hu, N
Li, B
Ou, Y
Tang, Y
Yao, S
Zhang, S
Kong, C-C
Liu, B
Wang, T
Xiao, W
Lu, B
Xia, Y
Zhou, J
Cai, F
Chen, P
Hu, S
Wang, H
Wu, J
Xu, Q
Hu, L
Jing, L
Li, J
Li, B
Liu, Q
Liu, Y
Lu, X
Peng, ZD
Qiu, X
Ren, Q
Tong, Y
Wang, Z
Wang, J
Wen, Y
Wu, Q
Xia, J
Xie, J
Xiong, X
Xu, S
Yang, T
Ye, H
Yin, N
Yuan, J
Zeng, Q
Zhang, B
Zheng, K
Cang, J
Chen, S
Du, F
Fan, Y
Fu, S
Ge, X
Guo, B
Huang, W
Jiang, L
Jiang, X
Jin, L
Liu, Y
Pan, Y
Ren, Y
Shan, Q
Wang, J
Wang, F
Wu, C
Zhang, X
Christiansen, IC
Granum, SN
Rasmussen, BS
Daugaard, M
Gambhir, R
Brandsborg, B
Steingrimsdottir, GE
Jensen-Gadegaard, P
Olsen, KS
Siegel, H
Eskildsen, KZ
Gatke, MR
Wibrandt, I
Heintzelmann, SB
Lange, KHW
Lundsgaard, RS
Amstrup-Hansen, L
Hovendal, C
Larsen, M
Lenstrup, M
Kobborg, T
Larsen, JR
Pedersen, AB
Smith, SH
Oestervig, RM
Rasmussen, L
Afshari, A
Andersen, C
Ekelund, K
Secher, EL
Beloeil, H
Lasocki, S
Venara, A
Biais, M
Ouattara, A
Sineus, M
Molliex, S
Legouge, ML
Wallet, F
Tesniere, A
Gaudin, C
Lehur, P
Forsans, E
De Rudnicki, S
Maudet, VS
Mutter, D
Sojod, G
Ouaissi, M
Regimbeau, J-M
Futier, E
Desbordes, J
Comptaer, N
El Manser, D
Ethgen, S
Lebuffe, G
Auer, P
Haertl, C
Deja, M
Legashov, K
Sonnemann, S
Wiegand-Loehnert, C
Falk, E
Habicher, M
Angermair, S
Laetsch, B
Schmidt, K
Von Heymann, C
Ramminger, A
Jelschen, F
Pabel, S
Weyland, A
Czeslick, E
Gille, J
Malcharek, M
Sablotzki, A
Lueke, K
Wetzel, P
Weimann, J
Lenhart, F-P
Reichle, F
Schirmer, F
Hueppe, M
Klotz, K
Nau, C
Schoen, J
Mencke, T
Wasmund, C
Bankewitz, C
Baumgarten, G
Fleischer, A
Guttenthaler, V
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Fragandreas, G
Georgopoulou, E
Katsika, E
Psarras, K
Synekidou, E
Verroiotou, M
Vetsiou, E
Zaimi, D
Anagnou, A
Apostolou, K
Melissopoulou, T
Rozenberg, T
Tsigris, C
Boutsikos, G
Kalles, V
Kotsalas, N
Lavdaiou, C
Paikou, F
Panagou, G-L
Spring, A
Arvaniti, K
Botis, I
Drimala, M
Georgakakis, G
Kiourtzieva, E
Ntouma, P
Prionas, A
Xouplidis, K
Dalampini, E
Giannaki, C
Iasonidou, C
Ioannidis, O
Lavrentieva, A
Lavrentieva, A
Papageorgiou, G
Kokkinoy, M
Stafylaraki, M
Gaitanakis, S
Karydakis, P
Paltoglou, J
Ponireas, P
Chaloulis, P
Provatidis, A
Sousana, A
Gardikou, VV
Konstantivelli, M
Lataniotou, O
Lisari, E
Margaroni, M
Stamatiou, K
Nikolaidis, E
Pnevmatikos, I
Sertaridou, E
Andreou, A
Arkalaki, E
Athanasakis, E
Chaniotaki, F
Chatzimichali, CA
Christofaki, M
Dermitzaki, D
Fiorentza, K
Frantzeskos, G
Geromarkaki, E
Kafkalaki, K
Kalogridaki, M
Karydi, K
Kokkini, S
Kougentakis, G
Lefaki, T
Lilitsis, E
Makatounaki, A
Malliotakis, P
Michelakis, D
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Nyktari, V
Palikyra, I
Papadakis, E
Papaioannou, A
Sfakianakis, K
Sgouraki, M
Souvatzis, X
Spartinou, A
Stefanidou, N
Syrogianni, P
Tsagkaraki, G
Arnaoutoglou, E
Arnaoutoglou, C
Bali, C
Bouris, V
Doumos, R
Gkini, K-P
Kapaktsi, C
Koulouras, V
Lena, A
Lepida, D
Michos, E
Papadopoulos, D
Paschopoulos, M
Rompou, VA
Siouti, I
Tsampalas, S
Ververidou, O
Zilis, G
Charlalampidoy, A
Christodoulidis, G
Flossos, A
Stamoulis, K
Chan, M
Tsang, MSC
Tsang, MS
Lai, ML
Yip, CP
Chan, HMH
Law, B
Li, WS
Chu, HM
Koo, EGY
Lam, CCJ
Cheng, KH
Lam, T
Chu, S
Lam, WY
Wong, KWK
Kwok, D
Hung, CYJ
Chan, WKJ
Wong, WL
Chung, CKE
Ma, SK
Kaushik, S
Shah, B
Shah, D
Shah, S
Ar, P
Muthuchellappan, R
Agarwal, V
Divatia, J
Kulkarni, A
Mishra, S
Nimje, G
Pande, S
Savarkar, S
Shrivastava, A
Thomas, M
Yegnaram, S
Hidayatullah, R
Chandra, S
Tantri, A
Puar, N
Niman, S
Indra, I
Hamzah, Z
Yuliana, A
Abidin, UN
Dursin, AN
Kurnia, A
Susanti, A
Handayani, D
Alit, MA
Arya, A
Senapathi, TGA
Utara, UH
Wid, WM
Wima, S
Wir, WM
Jehosua, B
Kaunang, J
Lantang, EY
Najoan, R
Waworuntu, N
Awad, H
Fuad, A
Geddoa, E
Geddoa, B
Khalaf, AR
Al hussaini, S
Albaj, S
Kenber, M
Bettinelli, A
Spadaro, S
Volta, CA
Giancarlo, L
Sottosanti, V
Copetti, E
Della Rocca, G
Spagnesi, L
Toretti, I
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Cardellino, S
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Fanfani, LC
Novelli, MT
Roasio, A
Bellandi, M
Beretta, L
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Bocchino, S
Cabrini, L
Corti, D
Landoni, G
Meroni, R
Moizo, E
Monti, G
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Plumari, VP
Taddeo, D
Testa, V
Winterton, D
Zangrillo, A
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Colangelo, C
Colangelo, A
Rotunno, G
Paludi, MA
Maria, CP
Pata, A
Parrini, V
Gatta, A
Nastasi, M
Tinti, C
Baroselli, A
Arrigo, M
Benevento, A
Bottini, C
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Gastaldi, C
Marchesi, A
Pascazio, A
Pata, F
Pozzi, E
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Tessera, G
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D'Andrea, R
Ghignone, F
Poggioli, G
Sibilio, A
Taffurelli, M
Ugolini, G
Ab Majid, MA
Ab Rahman, R
Joseph, J
Pathan, F
Shah, MHS
Yap, HL
Cheah, S
Chin, II
Looi, JK
Tan, SC
Visvalingam, S
Kwok, FY
Lee, CK
Tan, TS
Wong, SM
Abdullah, NH
Liew, CF
Luxuman, L
Zin, NHM
Norddin, MF
Alias, RLR
Wong, JY
Yong, J
Bin Mustapha, MT
Chan, WK
Dzulkipli, N
Kuan, PX
Lee, YC
Alias, A
Guok, EC
Jee, CC
Ramon, BR
Wong, CW
Ghafar, FNIA
Aziz, FZ
Hussain, N
Lee, HS
Sukawi, I
Woon, YL
Hadi, HZA
Azam, UAA
Alias, AH
Kesut, SA
Lee, JM
Ooi, DV
Sulaiman, HA
Lih, TAT
Mansor, M
Veerakumaran, J
Luna, P
Rojas, E
Resendiz, GEA
Zapata, DDM
Lopez, JCJA
Flores, AAA
Amador, JCB
Avila, EJD
Aquino, LPG
Rodriguez, RL
Landa, MT
Urias, E
Hollmann, M
Hulst, A
Preckel, OKB
Koopman-van Gemert, A
Bouwman, A
Buise, M
Tolenaar, N
Weber, E
De Fretes, J
Houweling, P
Ormskerk, P
Van Bommel, J
Buhre, W
Lance, M
Smit-Fun, V
Van Zundert, T
Baas, P
De Boer, HD
Sprakel, J
Elferink-Vonk, R
Noordzij, P
Van Zeggeren, L
Brand, B
Spanjersberg, R
Ten Bokkel-Andela, J
Numan, S
Van Klei, W
Van Zaane, B
Boer, C
Van Duivenvoorde, Y
Hering, JP
Van Rossum, S
Zonneveldt, H
Campbell, D
Hoare, S
Santa, S
Ali, M
Allen, SJ
Beavis, V
Bell, R
Campbell, D
Choi, H-MD
Drake, M
Farrell, H
Hayes, K
Higgie, K
Holmes, K
Jenkins, N
Kim, CJ
Kim, S
Law, KC
McAllister, D
Park, K
Pedersen, K
Pfeifer, L
Pozaroszczyk, A
Salmond, T
Steynor, M
Tan, M
Short, T
Waymouth, E
Ab Rahman, AS
Armstrong, J
Dudson, R
Jenkins, N
Nilakant, J
Richard, S
Virdi, P
Dixon, L
Donohue, R
Farrow, M
Kennedy, R
Marissa, H
McKellow, M
Nicola, D
Pascoe, R
Roberts, SJ
Rowell, G
Sumner, M
Templer, P
Chandrasekharan, S
Fulton, G
Jammer, I
More, R
Wilson, L
Chang, YH
Foley, J
Fowler, C
Panckhurst, J
Sara, R
Stapelberg, F
Cherrett, V
Ganter, DL
McCann, L
Gilmour, F
Lumsden, R
Moores, M
Olliff, S
Sardareva, E
Tai, J
Wikner, M
Wong, C
Chaddock, M
Czepanski, C
McKendry, P
Polakovic, D
Polakovich, D
Robert, A
Belda, MT
Norton, T
Alherz, F
Barneto, L
Ramirez, A
Sayeed, A
Smith, N
Bennett, C
McQuoid, S
Jansen, T-L
Nico, Z
Scott, J
Freschini, D
Freschini, A
Hopkins, B
Manson, L
Stoltz, D
Bates, A
Davis, S
Freeman, V
McGaughran, L
Williams, M
Sharma, SB
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Byrne, K
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Johnson, R
Manikkam, B
Naidoo, S
Rumball, M
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Item Type: Journal Article
Abstract: 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 a median 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.
Issue Date: 1-Nov-2016
Date of Acceptance: 1-Nov-2016
URI: http://hdl.handle.net/10044/1/61656
DOI: https://dx.doi.org/10.1093/bja/aew316
ISSN: 0007-0912
Publisher: Elsevier
Start Page: 601
End Page: +
Journal / Book Title: British Journal of Anaesthesia
Volume: 117
Issue: 5
Copyright Statement: © 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Science & Technology
Life Sciences & Biomedicine
Anesthesiology
cohort studies
critical care/utilisation
operative/mortality
postoperative care/methods
postoperative care/statistics and numerical data
surgery
surgical procedures
Adolescent
Adult
Aged
Aged, 80 and over
Critical Care
Elective Surgical Procedures
Female
Global Health
Hospital Mortality
Humans
Length of Stay
Male
Middle Aged
Postoperative Complications
Poverty
Prospective Studies
Socioeconomic Factors
Treatment Outcome
Young Adult
International Surgical Outcomes Study group
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer