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• W1937756469 abstract "It is a basic tenet of medicine to measure the effects of care. This includes not just immediate responses to treatments but also outcomes, the most dramatic and conclusive being mortality. Understanding death rates is essential for understanding the impact of perioperative care. It provides indispensable guidance for clinicians to determine the risks and benefits of intervention, for patients to weigh those risks, and for systems of healthcare to evaluate performance, learn from those that perform well (or poorly), and establish benchmarks for improvement. In this issue of the Journal, Lillie et al. present an audit of 18,010 patients who underwent surgery at the University Teaching Hospital (UTH) in Lusaka, Zambia during 2012 – a similar audit was reported 25 years previously. The authors reviewed the six-day postoperative mortality rates as well as the likelihood that the death was preventable. Of this total obtained from hospital administrative records, the investigators identified 11,688 surgical cases from operating room registers (a 35% loss from the administrative log). By cross-referencing data from the hospital mortuary as well as death reports from the surgical and obstetrics wards, the authors were able to identify 114 deaths that occurred within six days of surgery. Tellingly, some 20-30% of cases came from direct reports from the ward nurses, undermining the reliability of the mortuary as a single data source for perioperative mortality. Of these 114 deaths, 59 cases had records available for review. When the authors investigated the preventability of these 59 postoperative deaths, they concluded that 14 were unavoidable and eight were unclear or indeterminate – that is, 60% of perioperative deaths were considered ‘‘avoidable’’ or ‘‘probably avoidable within available resources’’. Factors contributing to avoidable mortality were surgical (i.e., poor preparation/judgement/technique and undue delays), anesthetic (i.e., poor preparation and postoperative care), and systemic (i.e., lack of available resources, especially blood, intensive care capabilities, and staffing). The authors also compared their findings with the last published audit from UTH in 1987. Even under the best possible circumstance (i.e. no deaths in any of the 6,322 cases missing from the theatre logs in the 2012 audit), they found no significant differences in mortality following surgery over the past two decades. Indeed, they noted that perioperative deaths may have actually increased during this time despite global trends showing reductions in surgical mortality. Additionally, preventable deaths appear as common as they were in 1987. As a first step, let’s consider these numbers as a whole. The authors report a 1% postoperative six-day mortality rate for UTH; whilst from a single centre, this is no worse than national mortality rates for surgery reported by wealthy countries such as the United States (1.14%) and the Netherlands (1.85%). At face value, the reported death rate appears acceptable, for despite differences in case mix, these patients generally present with advanced acute illness and significant comorbidities, including malnutrition, anemia (i.e., both chronic as well as T. G. Weiser, MD, MPH (&) Department of Surgery, Stanford University Medical Center, 300 Pasteur Dr, S067, Stanford, CA 94305, USA e-mail: tweiser@stanford.edu" @default.
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• W1937756469 date "2015-09-21" @default.
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• W1937756469 title "Improving perioperative outcomes in low-resource countries: It can’t be fixed without data" @default.
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• W1937756469 doi "https://doi.org/10.1007/s12630-015-0484-y" @default.
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