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 Using mortality rates within 24 hours and 30 days after emergency
abdominal surgery as a measure, the study covered 58 countries and
found risk of death was three times higher in low-income compared to
high-income nations.
“Safety practices at the time of surgery are now embedded in
high-income settings, which have the resources to plan and deliver
them,” said study coauthor Dr. Aneel Bhangu, from the University of
Birmingham in the U.K.
“They are less routinely used in low and middle income countries,
due to a lack of resources and training in safety cultures,” which
may include equipment sterility, availability of antibiotics, and
type of skin preparation used at the time of surgery, he told
Reuters Health by email.
“Around the time of surgery, lack of critical care facilities and
imaging due to resources may also affect outcome adversely,” Bhangu
said.
For the study, 357 medical centers reported data on more than 10,000
patients receiving emergency abdominal surgery over a six-month
period in 2014, not including women undergoing cesarean section.
Many surgeries involved the appendix or gallstones.
Sixty percent of the patient records collected came from high-income
countries like the U.S., U.K. and Sweden, while the rest came from
middle-income countries like Egypt and low-income countries like
Mozambique.
There were 174 deaths within 24 hours of surgery and 404 deaths
within the following 30 days. In the first 24 hours, mortality rates
were about 1 percent in high-income countries, 2 percent in
middle-income countries and 3.4 percent in low-income countries. By
the 30-day mark, mortality rates were 4.5 percent, 6 percent and 8.6
percent, respectively.
Trauma leading to surgery was more common in lower income countries,
according to the results in the British Journal of Surgery.
“There is a lack of safe and affordable surgery in low- and
middle-income countries,” Bhangu said.
“This means that patients can take some days to get to hospital, or
may choose to avoid medical treatment in the first instance due to
cost,” he said. “In total, this may be creating the situation where
diseases are more advanced when the patient reaches the operating
theater.”
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Some strategies, like using a surgical safety checklist, may be
effective in high and low-income settings, or may be a marker of
safer hospital systems, he said.
“Given the lack of essential resources and immediate availability of
highly trained providers of all cadres, including technicians,
nurses, physician’s assistants, physicians and surgeons, surgery is
more dangerous in many low-income countries than it is in higher
income countries,” said Dr. Barclay Stewart of the University of
Washington in Seattle, who was not part of the new study.
“We all must advocate for greater global attention on the extreme
inequity that is represented by the lack of emergency and surgical
care in low-income countries,” Stewart told Reuters Health by email.
“This is particularly true for those of us who work in the global
health community, which is often focused on highly politicized
conditions that exact a lesser toll on societies than conditions
that require emergency and surgical care.”
Living in richer countries is associated with increased survival in
general, not just for emergency surgery, said Dr. Mark G. Shrime,
director of research in the Program in Global Surgery and Social
Change at Harvard Medical School in Boston who also was not part of
the new study.
Currently, 5 billion people around the world don't have this sort of
access to available, safe, affordable and timely care, Shrime told
Reuters Health by email, “and, of those who do, 80 million people
impoverish themselves every year trying to get surgery.”
SOURCE: http://bit.ly/1NqTkqG British Journal of Surgery, online May
4, 2016.
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