Lower GDP means poorer surgical outcomes

Results of our new research, a collaboration between our team of scientists at the Universities of Sheffield, Birmingham and Edinburgh, has shown that patients undergoing emergency surgery in lower-income countries have a three times greater chance of dying than in higher income countries. The study monitored post-surgery death rates and mapped them against the Human Development Index (HDI) of each country. A total of 10,745 patients were monitored up to 30 days after they underwent emergency abdominal surgery, at hospitals in 58 participating countries.

Published in British Journal of Surgery, results of the study showed that death rates were three times higher in low-income countries than in high-income countries, even after adjustment for prognostic factors such as fitness for surgery, diabetes history and smoking status. The study demonstrates a need to find ways of making surgery safer for patients in poor countries, such improving the use of the surgical safety checklists – the standard global marker of hospital safety. This study is not only important due to the findings, it has demonstrated that hundreds of doctors and students can work as a team across the globe to deliver large studies which can make a real difference to our understanding of surgical patient care. We want to build upon this success as a community by delivering surgical trials which will improve the safety and outcomes for patients across the world. We hope to take these findings and start to investigate the reasons behind these differences. Already we have an international network of surgeons and researchers across the world to tackle these important priorities head on. Improving access and quality of surgical care will help to improve the lives of patients across the globe.

It is believed that less than a third of the world’s population have access to safe, timely and affordable surgery. Only six per cent of the 300 million surgical procedures performed each year take place in low or middle-income countries, despite a third of the world’s population living there. Surgical death rates are routinely collected in high-income countries, such as the United Kingdom and the United States, but there is little to no surveillance in as many as 70 per cent of low and middle-income countries. As my colleague, Dr Aneel Bhangu from the University of Birmingham explains “The association between increasingly mortality and lower income countries might be explained by differences in prognosis, in treatment, or maybe both. What we can say is that our study highlights the significant disparity between countries, and an urgent need to address it.”

Our collaborative research team has developed a novel model of data collection, forming an international collaboration of doctors known as ‘GlobalSurg’. This network was created largely using social media, and data capture during the study was improved by use of a novel platform accessible from mobile internet devices.

By creating an international network of surgeons it has been possible to collect data on real patients, at the bedside to measure surgical outcomes. We reversed the traditional research model and recruited study collaborators via social media and other avenues. This established a data-sharing platform that is accessible from smartphones.

We also analysed the types of surgery being conducted. Regardless of income setting, the most commonly performed emergency abdominal operation was removal of the appendix.

As governments and the World Health Organisation move to address the deficiencies in global surgery, we must truly understand how best to do this, as Mr Ewen Harrison from the University of Edinburgh describes; “Improving surgical access and safety can only be achieved if we really understand what influences surgical outcomes on a global scale”.

The GlobalSurg team hopes the ongoing research will build on the findings and look to identify targets to help improve the safety of operations for surgical patients around the world. One example is our latest study, which aims to map antibiotic resistance across the world. This is crucial, as without effective antibiotics, life-saving surgery could not be performed. This study is still looking for hospitals across the world to take part and anyone, anywhere can be involved and help to deliver better care for patients in future.

www.globalsurg.org

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