Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1·6 per cent at 24 h (high 1·1 per cent, middle 1·9 per cent, low 3·4 per cent; P < 0·001), increasing to 5·4 per cent by 30 days (high 4·5 per cent, middle 6·0 per cent, low 8·6 per cent; P < 0·001). Of the 578 patients who died, 404 (69·9 per cent) did so between 24 h and 30 days following surgery (high 74·2 per cent, middle 68·8 per cent, low 60·5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2·78, 95 per cent c.i. 1·84 to 4·20) and low-income (OR 2·97, 1·84 to 4·81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov).

Mortality of emergency abdominal surgery in high-, middle- and low-income countries / A. Bhangu, J.E.F. Fitzgerald, S. Fergusson, C. Khatri, H. Holmer, K. Søreide, E.M. Harrison, T.M. Drake, A. Bhangu, N. Gobin, A. Vega Freitas, N. Hall, S.-. Kim, A. Negida, Z. Jaffry, S.J. Chapman, A.P. Arnaud, S. Tabiri, G. Recinos, M. Mohan, R. Amandito, M. Shawki, M. Hanrahan, F. Pata, J. Zilinskas, A.C. Roslani, C.C. Goh, A.O. Ademuyiwa, G. Irwin, S. Shu, L. Luque, H. Shiwani, A. Altamimi, M. Ubaid Alsaggaf, R. Spence, S. Rayne, J. Jeyakumar, Y. Cengiz, D.A. Raptis, J.C. Glasbey, C. Fermani, R. Balmaceda, M. Marta Modolo, E. Macdermid, R. Chenn, C. Ou Yong, M. Edye, M. Jarmin, S.K. D'amours, D. Iyer, D. Youssef, N. Phillips, J. Brown, R. George, C. Koh, O. Warren, I. Hanley, M. Dickfos, C. Nawara, D. Öfner, F. Primavesi, A.R. Mitul, K. Mahmud, M. Hussain, H. Hakim, T. Kumar, A. Oosterkamp, P.A. Assouto, I. Lawani, Y. Imorou Souaibou, A. Kyaw Tun, C. Leung Chong, G.H. Devadasar, M. Rashid Minhas Qadir, K. Phyo Aung, L. Shi Yeo, V.D. Palomino Castillo, M. Moron Munhoz, G. Moreira, L.C. Barros De Castro Segundo, S. Anderson Khouri Ferreira, M. Cassa Careta, S. Binna Kim, A. Venâncio De Sousa, A. Daltri Lazzarini Cury, G. Peixoto Soares Miguel, A. Vega Carreiro De Freitas, B. Pereira Silvestre, J. Guasti Pinto Vianna, C. Oliveira Felipe, L. Alberto Valente Laufer, F. Altoe, L. Ayres Da Silva, M.L. Pimenta, T. Fernandes Giuriato, P. Alves Bezerra Morais, J. Souza Luiz, R. Araujo, J. Menegussi, M. Leal, C. Vinícius Barroso de Lima, L. Sarmento Tatagiba, A. Leal, D. Vinicius dos Santos, G. Pereira Fraga, R. Lages Simoes, S. Stock, S. Nigo, J. Kabba, T. Ebogo Ngwa, S. King, A. Zani, G. Azzie, M. Firdouse, S. Kushwaha, A. Agarwal, K. Bailey, B. Cameron, M. Livingston, A. Horobjowsky, D.L. Deckelbaum, T. Razek, B. Marinkovic, E. Grasset, N. D'aguzan, J. Jimenez, R. Macchiavello, Z. Zhang, W. Guo, J. Oh, F. Zheng, I. Montes, S. Sierra, M. Mendez, M.I. Villegas, M.C. Mendoza Arango, I. Mendoza, F.A. Naranjo Aristizã bal, J.A. Montoya Botero, V.M. Quintero Riaza, J. Restrepo, C. Morales, H. Cruz, A. Munera, R. Karlo, E. Domini, J. Mihanovic, M. Radic, K. Zamarin, N. Pezelj, M. Hache-Marliere, S. Batista Lemaire, R. Rivas, A. Khyrallh, A. Hassan, G. Shimy, M.A. Baky Fahmy, A. Nabawi, M.S. Ali Muhammad Gohar, M. Elfil, M. Ghoneem, M. Asal, M. Abdelkader, M. Gomah, H. Rashwan, M. Karkeet, A. Gomaa, A. Hasan, A. Elgebaly, O. Azzam, A. AbdelFattah, A. Gouda, A. Elshafay, A. Gharib, A. Menshawy, M. Hanafy, A. Al-Mallah, M. Abdulgawad, M. Baheeg, M. Alhendy, I.A. Fattah, A. Kenibar, O. Osman, M. Gemeah, A. Mohammed, A. Adel, A. Sayed, M. Abozaid, A. Hafez El-Badri Kotb, A.A. Ahmed Ata, M. Nasr, A. Alkammash, M. Saeed, N. Abd El Hamid, A.M. Attia, A. Abd El Galeel, E. Elbanby, K. Salah El-Dien, U. Hantour, O. Alahmady, B. Mansour, A.M. Elkorashy, E.M. Saeed Taha, K.T. Lasheen, S. Said Elkolaly, N. Yosri Elsayed Abdel-Wahab, M.A. Fathi Abozyed, A.M. Saeed, G. Samir El Sayed, J.H. Youssif, S. Magdy Ahmed, N. Soubhy El-Shahat, A. Hegazy Khedr, A. Osama Elsebaaye, M. Elzayat, M. Abdelraheim, I. Elzayat, M. Warda, K. Naser El Deen, A. Essam Elnemr, O. Salah, M. Abbas, M. Rashad, I. Elzayyat, D. Hemeda, G. Tawfik, M. Salama, H. Khaled, M. Seisa, K. Elshaer, A. Hussein, M. Elkhadrawi, A.M. Afifi, O. Saadeldeen Ebrahim, M.M. Metwally, R. Elmelegy, D.M. Elbendary Elsawahly, H. Safa, E. Nofal, M. Elbermawy, M. Abo Raya, A. Abdelmotaleb Ghazy, H. Samih, A. Abdelgelil, S. Abdelghany, A. El Kholy, F. Elkady, M. Salma, S. Samy, R. Fakher, A. Aboarab, A. Samir, A. Sakr, A. Haroun, A. Abdel-Rahman Al-Aarag, A. Elkholy, S. Elshanwany, E. Ghanem, A. Tammam, A.M. Hammad, Y. El Shoura, G. El Ashal, H. Khairy, S. Antar, S. Mehrez, M. Abdelshafy, M. Gamal Mohamad Hamad, M. Farid Hosh, E. Abdallah, B. Magdy, T. Alzayat, E. Gamaly, H. Elfeki, A. Abouzahra, S. Elsheikh, F. Elgendy, F. Abd El-Salam, O. Seifelnasr, M. Ammar, A. Eysa, A. Sadek, A. Gamal Toeema, K. Shady, A. Nasr, M. Abuseif, H. Zidan, S. Abd Elmageed Barakat, N. Elsayed, Y. Abd Elrasoul, A. Elkelany, M. Sabry Ammar, M. Mustafa, Y. Hegazy, M. Etman, S. Saad, M. Alrahawy, A. Raslan, M. Morsi, A. Rslan, A. Sabry, H. Elwakil, H. Shaker, Y. Abd-Elrasoul, H. El-Kashef, M. Shaalan, A. Tarek, A. Elwan, A. Ragab Nayel, M. Seif, D. Emadeldin, M. Ali Ghonaim, A. Almallah, A. Fouad, E. Adel Sayma, A. Elbatahgy, A. Solaiman El-Ma'doul, A. Mosad, H. Tolba, D. Eldin Abdelazeem Amin Elsorogy, H. Ali Mostafa, A. Atef Omar, O. Sherief Abd El Hameed, A. Lasheen, Y. Abd El Salam, A. Morsi, M. Ismail, H. Ahmed El-badawy, M. Amer, A. Sabry El-Hamouly, N. Ahmed Attallah, O. Mosalum, A. Afandy, A. Mokhtar, A. Abouelnasr, S. Ayad, R. Shaker, R. Sakr, M. Amreia, S. Elsobky, A. Abo El Magd, A. Marey, A. Tarek Hafez, M. Zalabia, M. Moamen Mohamed, A. Fadel, E. Ali Ahmed, A. Ali, M. Ghassan Alwafai, A. Dwydar, S. Kharsa, E. Mamdouh, H. El-Sheemy, I. Youssef, A. Khairy Aly, A. Aldalaq, E. Alnawam, D. Alkhabbaz, M. Saad, S. Hussein, A. Abo Elazayem, A. Ramadan, M. Elashmawy, M. Mousa, A. Nashaat, S. Ghanem, Z. Oof, A. Elwaey, I. Elkadsh, M. Darweesh, A. Mohameden, M. Hafez, A. Badr, A. Badwy, M. Abd El Slam, M. Elazoul, S. Al-Nahrawi, L. Eldamaty, F. Nada, M. Ameen, A. Hagar, M. Elsehimy, M. Aboraya, H. Dawoud, S. El Mesery, A. El Gendy, A. Abdelkareem, A. Safwan Marey, M. Allam, S. Shehata, K. Abozeid, M. Elshobary, A. Fahiem, S. Sarsik, A. Hashish, M. Zidan, M. Hashish, A. Sanad, M. Mesalam, S. Aql, A. Osman Abdelaziz Elhendawy, M. Husseini, E. Kasem, A. Gheith, Y. Elfouly, A. Ragab Soliman, Y. Ibrahim, N. Elfouly, A. Fawzy, M. Rashid, A. Salah Elsherbiny, B. Sieda, N. Badwi, M.M. Hassan Mohammed, O. Mohamed, M. Abdulkhalek Habeeb, M. Worku, N. Starr, S. Desta, S. Wondimu, N.S. Abebe, E. Thomas, F.A. Asele, D. Dabessa, N. Seyoum Abebe, A.B. Zerihun, P. Mentula, A. Leppäniemi, V. Sallinen, A. Scalabre, F. Frade, S. Irtan, V. Graffeille, E. Gaignard, Q. Alimi, V. Graffieille, O. Abbo, S. Mouttalib, O. Bouali, E. Hervieux, Y. Aigrain, N. Botto, A. Faure, L. Fievet, N. Panait, E. Eyssartier, F. Schmitt, G. Podevin, V. Parent, A. Martin, C. Muller, A. Bonnard, M. Peycelon, F. Abantanga, K. Boakye-Yiadom, M. Bukari, F. Owusu, J. Awuku-Asabre, L.D. Bray, D. Lytras, K. Psarianos, A. Bamicha, E. Kefalidi, G. Gemenetzis, C. Dervenis, N. Gouvas, C. Agalianos, M. Kontos, G. Kouraklis, D. Karousos, S. Germanos, C. Marinos, C. Anthoulakis, N. Nikoloudis, N. Mitroudis, S. Estupinian, W. Forno, J.R. Arévalo Azmitia, C.C. Ramã-rez Cabrera, R. Guevara, M. Aguilera, N. Mendez, C.A. Azmitia Mendizabal, P. Ramazzini, M. Contreras Urquizu, F. Tale, R. Soley, E. Barrios, D.E. Marroquín Rodríguez, C.I. Pérez Velásquez, S.M. Contreras Mérida, F. Regalado, M. Lopez, M. Siguantay, F.Y. Lam, K.J.-. Szeto, C.C.L. Szeto, W.S. Li, K.K.K. Li, M.F. Leung, T. Mak, S. Ng, S.S. Prasad, A. Kirishnan, N. Gyanchandani, S. Bhat, A. Sreedharan, S.V. Kinnera, B.S. Kumar, M. Rangarajan, Y. Reddy, C. Venugopal, S. Kumar, A. Mittal, S. Nadkarni, H.N. Lakshmi, P. Malik, N. Limaye, S. Pai, P. Jain, M. Khajanchi, S. Satoskar, R. Satoskar, A. BinMahamood, E.P. Refianti Sutanto, D.A. Soeselo, C. Tedjaatmadja, F.N. Rahmawati, M. Mayasari, R.K.M. Jawad Al-Hasani, H.I. Ibraheem Al-Hameedi, I.A. Aziz Al-Azraqi, L. Sabeeh, R. Kamil, M. Mezeil Telfah, A. Rasendran, J. Sheehan, R. Kerley, C. Normile, R.W. Gilbert, J. Song, M. Dablouk, L. Mauro, M.O. Dablouk, P. Kielty, E. Marks, S. Gosling, M. Mccarthy, D. Mirghani, S. Altaf Naqvi, C.S. Wong, S. Chung, R. D'cruz, R. Cahill, S.G. Gosling, C. Fahy, D. Duarte Cadogan, A. Powell, R. Gilbert, C. Clifford, A. Driscoll, P. Stassen, C. Lee, R. Bowe, W. Hutch, H. Mohan, M. O'Neill, K. Mealy, P. Danelli, A. Bondurri, A. Maffioli, M. Pasini, G. Pata, S. Roncali, P. Silvani, M. Carlucci, R. Faccincani, L. Bonavina, Y. Macchitella, C. Ceriani, G. Tugnoli, S. Di Saverio, K. Khattab, M. Angel Paludi, D. Pata, L. Maria Cloro, A. Allegri, L. Ansaloni, F. Coccolini, E. Veronese, L. Bortolasi, A. Hasheminia, G. Nastri, M. Dal Canto, S. Cucumazzo, A. Benevento, G. Tessera, P. Paolo Grandinetti, A. Maniscalco, G. Luca Lamanna, L. Turati, G. Sgroi, E. Rausa, R. Villa, M. Monteleone, D. Merlini, V. Grassi, R. Cirocchi, A. Cacurri, H. Waleed, A. Diab, F. Elzowawi, M. Jokubauskas, K. Varkalys, D. Venskutonis, R. Pranevicius, V. Ambrozeviciute, S. Juciute, A. Skardžiukaitė, S. Bradulskis, L. Urbanavicius, A. Austraite, R. Riauka, Z. Dambrauskas, P. Karumnas, Z. Urniezius, R. Zilinskiene, A. Rudzenskaite, A. Usaityte, M. Montrimaite, N. Kaselis, A. Strazdas, K. Jokubonis, K. Maceviciute, E. Laugzemys, A. Kolosov, V. Jotautas, I. Rakita, S. Mikalauskas, D. Kazanavicius, R. Rackauskas, K. Strupas, T. Poskus, V. Beisa, R. Rakauskas, E. Preckailaite, R. Coomber, K. Johnson, J. Nowers, D. Periasammy, A. Salleh, A. Das, R. Goh Ern Tze, M. Nirumal Kumar, N.A. Nik Abdullah, N.R. Kosai, M. Taher, R. Rajan, H.Y. Chong, A.C. Roslani, C.C. Goh, M. Agius, E. Borg, M. Bezzina, R. Bugeja, M. Vella-Baldacchino, A. Spina, J. Psaila, H. Francois-Coridon, C. Tolg, J.-. Colombani, C. Diaz-Zorrilla, A. Ramos-De La Medina, S. Corro-Diaz Gonzalez, M. Jacobe, D. Mapasse, E. Snyder, R. Oumer, M. Osman, A. Mohammad, L.-. Anyanwu, A. Sheshe, A. Adesina, O. Faturoti, O. Taiwo, M. Habib Ibrahim, A.A. Nasir, S. Itopa Suleiman, A. Adeniyi, O. Adesanya, A. Adebanjo, R. Osuoji, K. Atobatele, A. Ogunyemi, O. Wiliams, M. Oludara, O. Oshodi, A. Ademuyiwa, A. Oluwagbemiga Lawal, F. Alakaloko, O. Elebute, A. Osinowo, C. Bode, A. Adesuyi, A. Tade, A. Adekoya, C. Nwokoro, O.O. Ayandipo, T. Akeem Lawal, A.E. Ajao, S. Sani Ali, B. Odeyemi, S. Olori, A. Popoola, A. Adeyeye, J. Adeniran, W.J. Lossius, I. Havemann, K. Thorsen, J.K. Narvestad, T.B. Wold, L. Nymo, M. Elsiddig, M. Dar, K.F. Bhopal, Z. Iftikhar, M.M. Furqan, B. Nighat, M. Jawaid, A. Khalique, A. Zil-E-Ali, A. Rashid, H. Abbas Dharamshi, T. Naqvi, A. Faraz, A.W. Anwar, T. Muhammad Yaseen, G.S. Shamsi, T. Yaseen, W. Anwer, H. Paredes Decoud, O. Aguilera, I.I. Zelada Alvarez, J. Marcelo Delgado, G.M. Machain Vega, H.A. Segovia Lohse, W.L. Messa Aguilar, J.A. Cabala Chiong, A.C. Manchego Bautista, E. Huaman, S. Zegarra, R. Camacho, J.M. Vergara Celis, D.A. Romani Pozo, J. Hamasaki, E. Temoche, J. Herrera-Matta, C.P. García Torres, L.M. Alvarez Barreda, R. Barrionuevo Ojeda, O. Garaycochea, M. Castro Mollo, M. Linares Delgado, F. Fujii, S.A. Durand, C.A. Arroyo Basto, N.M. Urbina Rojas, S.B. Shu Yip, A.L. Contreras Vergara, A. Echevarria Rosas Moran, G. Borda Luque, M. Rodriguez Castro, R. Alvarado Jaramillo, G. Manrique Sila, C.E. Lopez, M. Zapata Ponze De Leon, M. Machaca, R. Coasaca Huaraya, A. Arenas, C. López, C. Milagros Herrera Puma, W. Pino, C. Hinojosa, S. Limache, G. Manrrique Sila, L.-. Mercado Rodriguez, R. Melo, J. Costa-Maia, N. Muralha, F. Sauvat, I. Dan, M. Hogea, P. Eduard, R.-. Bratu, M. Beuran, I.-. Diaconescu, B.-. Martian, F.-. Iordache, M. Vartic, L.C. Vida, L.I. Muntean, A.S. Mironescu, V.J.P. Nsengimana, A. Niragire, J.D.L.C. Allen Ingabire, E. Niyirera, N. Zanini, E. Jovine, G. Landolfo, I.N. Alomar, S.A. Alnuqaydan, A.M. Altwigry, M. Othman, N. Osman, E. Alqahtani, M. Alzahrani, R. Alyami, E. Aljohani, I. Alhabli, Z. Mikwar, S. Almuallem, A. Nawawi, M. Bakhaidar, A.A. Maghrabi, M. Alsaggaf, M. Aljiffry, A. Altaf, A. Khoja, A. Habeebullah, N. Akeel, N. Ghandora, A. Almoflihi, A. Huwait, A. Al-shammari, M. Al-Mousa, M. Alghamdi, W. Adham, B. Albeladi, M.A. Alfarsi, A. Mahdi, S. Al Awwad, T. Nouh, M. Hassanain, S. Aldhafeeri, N. Sadig, O. Algohary, M. Aledrisy, A. Gudal, A. Alrifaie, M. AlRowais, A. Althwainy, A. Shabkah, U. Alamoudi, M. Alrajraji, B. Alghamdi, S. Aljohani, A. Daqeeq, J.J. Al-Faifi, V. Jennings, N. Ngayu, R. Moore, V. Kong, H. Kretzmann, K. Connor, D. Nel, C. Sampson, E. Panieri, N. Sishuba, M. Tun, A.M. Mphatsoe, J.A. Carreira, E. Teasdale, M. Wagener, S. Botes, D. Du Plessis, F. Fernandez-Bueno, J. Aguilar-Jimenez, J.A. Garcia-Marin, L.S. García, L.J. García Florez, R. Darío Arias Pacheco, J. Pagnozzi, J.H. Jara Quezada, J.L. Rodicio, G. Minguez, R. Rodríguez-Uría, P. Ugalde, C. Lopez-Arevalo, L. Barneo, J.P. Gonzales Stuva, I. Ortega-Vazquez, L. Rodriguez, N. Herrera, P. Pitigala Arachchi, W.S.M. Kithsiri Janakantha Senanayake, L.A.J. Jayasooriya Arachchige, S. Sivaganesh, D.I. Samaraweera, V. Thanusan, A.E.K. Musa, R.M.H. Balila, M.A.E.H. Mohamed, H. Ali, H. Zain Elabdin, S. Mahdi, H. Ahmed, S. Abdoun Ishag Idris, M. Elsayed, M. Mahmoud, M. Boijsen, P.-. Lundgren, U. Gustafsson, A. Kiasat, F. Wogensen, E. Jurdell, A. Thorell, H. Thorarinsdottir, M. Utter, S.M. Sundstrom, C. Wredberg, A. Kjellin, J. Nyberg, B. Frisk, M. Sund, L. Andersson, U. Gunnarsson, S. Ahlqvist, I. Björklund, H. Royson, P. Weber, H.-. Pahlsson, E. Borin, M. Hjertberg, R. Schmid, D. Schivo, V. Despotidis, S. Breitenstein, R.F. Staerkle, E. Schadde, F. Deichsel, A. Gerosa, A. Nocito, B. Mijuskovic, M. Zuber, L. Eisner, S. Kruspi, K.B. Reinisch, C. Schoewe, A. Novak, A.F. Palma, G. Teufelberger, M. Kimaro, R. King, A. Zeynel, A. Balkan, M. Gumar, M. Ali Yavuz, U. Karabacak, G. Lap, B.B. Ozkan, M. Karakahya, R. Adams, R. Morton, L. Henderson, R. Gratton, K.D. Clement, K. Yu-Ching Chang, D. Mcnish, R. Mcintosh, W. Milligan, B. Skelly, H. Anderson-Knight, R. Lawther, J. Onimowo, V. Shatkar, S. Tharmalingam, E. Woin, T. Fautz, O. Ziff, S. Dindyal, S. Talukder, S. Arman, V. Gadhvi, L.S. Chew, J. Heath, N. Blencowe, S. Hallam, K. Gash, G. Singh Mannu, D.-. Zachariades, A.C. Snaith, T.S. Hettiarachchi, A. Nesaratnam, J. Wheeler, D. McCullagh, J.M. Clements, A. Khan, F. Koumpa, C. Neophytou, J. Roth, W.C. Soon, M. Deputy, A. Ahmed, A. Ashton, J. Vincent, J. Almy, T. Khan, J.L.Y. Allen, C.J. Mcintyre, D.C. Marshall, M. Sykes, N. Behar, H. Jordan, Y. Rajjoub, T. Sherman, T. White, A. Watts, R. Ardley, T. Arulampalam, A. Shah, D. Brown, E. Blower, P. Sutton, K. Gasteratos, D. Vimalachandran, C. Magee, A. Mcguigan, S. Mcaleer, C. Morgan, S. Braungart, K. Lafferty, P. Labib, A. Tanase, C. Mangan, L. Reza, H. Woodward, C. Gouldthorpe, M. Turner, J.R.L. Wild, T.A.M. Malik, V.K. Proctor, K. Hewage, J. Davies, A. Dubois, S. Sarwary, A. Zardab, A. Grant, R. Mcintyre, Y.P. Mogan, W. Ho, B.F. Hon Khi Chong, S. Tewari, G. Humm, E. Farinella, N.J. Hall, N.J. Wright, C.P. Major, T. Xerri, P. De Bono, J. Amin, M. Farhad, J.F. Camilleri-Brennan, A.G.N. Robertson, J. Swann, J. Richards, A. Jabbar, M. Attard, H. Burns, E. Macdonald, M. Baldacchino, J. Skehan, J. Camilleri-Brennan, T. Falconer Hall, M. Gimzewska, G. Mclachlan, J. Shah, J. Giles, S. Chiu, B. Weber, S. Man Yeng Chiu, S. Highcock, M. Hassan, W. Beasley, A. Vlachogiorgos, S. Dias, G. Maharaj, R. Mcdonald, A. Macdonald, P. Witherspoon, A. Baird, P. Sarmah, N. Green, H. Youssef, K. Cross, C.M. Rees, B. Van Duren, E. Upchurch, K. Khan, H. Abudeeb, A. Hammad, S. Karandikar, D. Bowley, A. Karim, W. Chachulski, L. Richardson, G. Dawnay, B. Thompson, A. Mistry, A. Bhangu, M. Ghetia, S. Roy, O. Al-Obaedi, K. Das, A. Prabhudesai, D.M. Cocker, J.J. Tan, R. Tyler, F. Di Franco, S. Ayyar, S. Vivekanantham, S. Gokani, M. Gillespie, K. Gudlaugsdottir, T. Pezas, C. Currow, M. Young-Han Kim, A. Birring, J. Edwards, S. Das, M. Jha, K. Atkinson, J. Luck, T. Fozard, M. Puttick, Y. Salama, R. Shah, A.A. Ibrahem, H. Ebdewi, G. Gravante, S. El-Rabaa, H. Nnajiuba, R. Allott, A. Bhargava, Z. Chan, Z. Hassan, M. Makinde, D. Hemingway, R. Dean, A. Boddy, A. Aber, V. Patel, J. Parakh, S. Parthiban, H.K. Ubhi, S.-. Hosein, S. Ward, K. Malik, L. Jennings, T. Newton, M. Alkhouri, M.K. Kang, C. Houlden, J. Barry, I. Raza, A. Farquharson, S. Bhattacharya, K. Chang, M.S.J. Wilson, Y.N. Neo, I. Ibrahim, E. Chan, F.S. Peck, P.J. Lim, A.S. North, R. Blundell, A. Williamson, D. Fouad, A. Minocha, K. Mccarthy, E. Court, A. Chambers, J. Yee, J.C. Tham, C. Beaton, U. Walsh, J. Lockey, S. Bokhari, L. Howells, M. Griffiths, L. Yallop, S. Singh, O. Nasher, P. Jackson, A.M. Shariffuddin, W.C. Ho, G. Pabla, S. Ramzi, S. Zeidan, J. Doughty, S. Sinha, R. Davenport, J. Lewis, L. Duffy, E. Mcaleer, E. Williams, R. Som, O. Javed, M. Boal, N. Harrison, H. Tafazal, T. Brogden, E. Griffiths, R.D. Obute, T.E. Glover, D.J. Clark, M. Boshnaq, M. Akhtar, P. Capleton, S. Doughan, M. Rabie, I. Mohamed, D. Samuel, L. Dickson, M. Kennedy, E. Dempster, E. Brown, N. Maple, E. Monaghan, B. Wolf, A. Garland, A. Mcphee, D. Anderson, R. Anderson, S. Hassan, D. Smith, J. Lund, C. Boereboom, J. Murphy, G. Tierney, S. Tou, E.F. Zimmermann, N.J. Smart, A.M. Warwick, T. Stasinou, I. Daniels, K. Findlay-Cooper, S. Mitrasinovic, S. Ray, M. Varcada, R.D.S. Omara, M. Spurr, L. Parkinson, A. Hanks, J. Ma, E. Abington, M. Ramcharn, G. Williams, J. Winstanley, E.D. Kennedy, E.N.W. Yeung, C. Jones, S. O'Neill, S.J. Lim, I. Liew, H. Nair, C. Fairfield, S. Koh, A. Wilson, D. Anandkumar, A. Kirupagaran, T.F. Jones, H.D. Torrance, A.J. Fowler, C. Chandrakumar, P. Patel, S.F. Ashraf, S.M. Lakhani, A.L. Mclean, S. Basson, J. Batt, C. Bowman, M. Stoddart, N. Benons, C. Mason, R. Harrison, J. Quayle, T. Barker, V. Summerour, E. Harper, C. Smith, M. Hampton, S.K. Pitt, A.E. Ward, T. O'Connor, E.G. Heywood, A. Chowdhury, S. Hossaini, N.F. Watson, D. Mckechnie, A. Farah, A. Chun, H. Koh, G. Lim, G. Sunderland, L. Gould, P.C. Munipalle, H. Rooney, D.R.L. Browning, B. Pereira, K. Nemeth, E. Decker, S. Giuliani, A. Shalaby, S. Shaikh, C.Y. Tan, E.Y.A. Palkhi, E. Kostov, P. Harbord, J. Barnacle, A. Szczap, S. Chidambaram, C.Y. Chen, K. Kulasabanathan, S. Chhabra, M.M. Palliyil, M. Zikry, J. Porter, C. Raslan, S. Hafiz, N. Soltani, K. Baillie, L. Marples, A. Macfarlane, R. Thurairaja, P. Singh, S. Sheth, K. Patel, M. Khalili, J. Choi, M. Benger, T. Boyce, H. Whewell, E. Jones, F. Th'ng, N. Robertson, A. Mirza, H. Saeed, S. Galloway, G. Elena, M. Afzal, M. Zakir, P. Sodde, C. Hand, A. Sriram, T. Clark, P. Holton, A. Livesey, Y. Sinha, F.M. Iqbal, I.S. Bharj, A. Rotundo, C. Jenvey, R. Slade, D. Golding, S. Haines, A.A. Ne'ma Abdullah, T.W. Tilston, D. Loughran, D. Donoghue, L. Giacci, M. Ashur Sherif, P. Harrison, A. Tang, D. Kotecha, M. Elshaer, T. Urbonas, A. Riaz, A. Chapman, P. Acharya, J. Shalhoub, C. Grossart, D. McMorran, M. Mlotshwa, W. Hawkins, S. Loizides, K. Krishna, M. Orchard, C.W. Ho, P. Thomson, S. Khan, F. Taylor, J. Shukla, E.E. Howie, L. Macdonald, O. Komolafe, N. Mcintyre, J. Cragg, J. Parker, D. Stewart, L. Lintin, J. Tracy, T. Farooq, G. Molina, H. Kaafarani, R. Beyene, J. Sava, M. Scott, M. Swaroop, R. Kennedy, I.A. Azodo, D. Heffernan, T. Chun, A. Stephen, M. Sion, M.S. Weinstein, V. Punja, N. Bugaev, M. Goodstein, S. Razmdjou, E. Etchill, J.C. Puyana, M. Kesinger, L. Napolitano, K. To, M. Hemmila, O. Todd, E. Jenner, E. Hoogakker, D. Roi, J.H. Chieh Chen, L. Ismail, E.G. Escobar. - In: BRITISH JOURNAL OF SURGERY. - ISSN 0007-1323. - 103:8(2016 Jul), pp. 971-988. [10.1002/bjs.10151]

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

P. Danelli;A. Bondurri;A. Maffioli;L. Bonavina;
2016

Abstract

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1·6 per cent at 24 h (high 1·1 per cent, middle 1·9 per cent, low 3·4 per cent; P < 0·001), increasing to 5·4 per cent by 30 days (high 4·5 per cent, middle 6·0 per cent, low 8·6 per cent; P < 0·001). Of the 578 patients who died, 404 (69·9 per cent) did so between 24 h and 30 days following surgery (high 74·2 per cent, middle 68·8 per cent, low 60·5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2·78, 95 per cent c.i. 1·84 to 4·20) and low-income (OR 2·97, 1·84 to 4·81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov).
abdomen; adult; checklist; cohort studies; digestive system surgical procedures; female; gastrointestinal diseases; humans; male; patient safety; quality assurance, health care; developed countries; developing countries; emergencies; surgery
Settore MED/18 - Chirurgia Generale
lug-2016
Article (author)
File in questo prodotto:
File Dimensione Formato  
2016-British_Journal_of_Surgery.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 525.45 kB
Formato Adobe PDF
525.45 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/553187
Citazioni
  • ???jsp.display-item.citation.pmc??? 79
  • Scopus 194
  • ???jsp.display-item.citation.isi??? 150
social impact