RT Journal Article
SR Electronic
T1 Perioperative mortality rates in low-income and middle-income countries: a systematic review and meta-analysis
JF BMJ Global Health
FD BMJ Publishing Group Ltd
SP e000810
DO 10.1136/bmjgh-2018-000810
VO 3
IS 3
A1 Joshua S Ng-Kamstra
A1 Sumedha Arya
A1 Sarah L M Greenberg
A1 Meera Kotagal
A1 Catherine Arsenault
A1 David Ljungman
A1 Rachel R Yorlets
A1 Arnav Agarwal
A1 Claudia Frankfurter
A1 Anton Nikouline
A1 Francis Yi Xing Lai
A1 Charlotta L Palmqvist
A1 Terence Fu
A1 Tahrin Mahmood
A1 Sneha Raju
A1 Sristi Sharma
A1 Isobel H Marks
A1 Alexis Bowder
A1 Lebei Pi
A1 John G Meara
A1 Mark G Shrime
YR 2018
UL http://gh.bmj.com/content/3/3/e000810.abstract
AB Introduction The Lancet Commission on Global Surgery proposed the perioperative mortality rate (POMR) as one of the six key indicators of the strength of a country’s surgical system. Despite its widespread use in high-income settings, few studies have described procedure-specific POMR across low-income and middle-income countries (LMICs). We aimed to estimate POMR across a wide range of surgical procedures in LMICs. We also describe how POMR is defined and reported in the LMIC literature to provide recommendations for future monitoring in resource-constrained settings.Methods We did a systematic review of studies from LMICs published from 2009 to 2014 reporting POMR for any surgical procedure. We extracted select variables in duplicate from each included study and pooled estimates of POMR by type of procedure using random-effects meta-analysis of proportions and the Freeman-Tukey double arcsine transformation to stabilise variances.Results We included 985 studies conducted across 83 LMICs, covering 191 types of surgical procedures performed on 1 020 869 patients. Pooled POMR ranged from less than 0.1% for appendectomy, cholecystectomy and caesarean delivery to 20%–27% for typhoid intestinal perforation, intracranial haemorrhage and operative head injury. We found no consistent associations between procedure-specific POMR and Human Development Index (HDI) or income-group apart from emergency peripartum hysterectomy POMR, which appeared higher in low-income countries. Inpatient mortality was the most commonly used definition, though only 46.2% of studies explicitly defined the time frame during which deaths accrued.Conclusions Efforts to improve access to surgical care in LMICs should be accompanied by investment in improving the quality and safety of care. To improve the usefulness of POMR as a safety benchmark, standard reporting items should be included with any POMR estimate. Choosing a basket of procedures for which POMR is tracked may offer institutions and countries the standardisation required to meaningfully compare surgical outcomes across contexts and improve population health outcomes.