World Journal of Surgery

, Volume 39, Issue 4, pp 856–864 | Cite as

Perioperative Mortality Rate (POMR): A Global Indicator of Access to Safe Surgery and Anaesthesia

  • David A. Watters
  • Michael J. Hollands
  • Russell L. Gruen
  • Kiki Maoate
  • Haydn Perndt
  • Robert J. McDougall
  • Wayne W. Morriss
  • Viliami Tangi
  • Kathleen M. Casey
  • Kelly A. McQueen



The unmet global burden of surgical disease is substantial. Currently, two billion people do not have access to emergency and essential surgical care. This results in unnecessary deaths from injury, infection, complications of pregnancy, and abdominal emergencies. Inadequately treated surgical disease results in disability, and many children suffer deformity without corrective surgery.


A consensus meeting was held between representatives of Surgical and Anaesthetic Colleges and Societies to obtain agreement about which indicators were the most appropriate and credible. The literature and state of national reporting of perioperative mortality rates was reviewed by the authors.


There is a need for a credible national and/or regional indicator that is relevant to emergency and essential surgical care. We recommend introducing the perioperative mortality rate (POMR) as an indicator of access to and safety of surgery and anaesthesia. POMR should be measured at two time periods: death on the day of surgery and death before discharge from hospital or within 30 days of the procedure, whichever is sooner. The rate should be expressed as the number of deaths (numerator) over the number of procedures (denominator). The option of before-discharge or 30 days is practical for those low- to middle-income countries where postdischarge follow-up is likely to be incomplete, but it allows those that currently can report 30-day mortality rates to continue to do so. Clinical interpretation of POMR at a hospital or health service level will be facilitated by risk stratification using age, urgency (elective and emergency), procedure/procedure group, and the American Society of Anesthesiologists grade.


POMR should be reported as a health indicator by all countries and regions of the world. POMR reporting is feasible, credible, achieves a consensus of acceptance for reporting at national level. Hospital and Service level POMR requires interpretation using simple measures of risk adjustment such as urgency, age, the condition being treated or the procedure being performed and ASA status.


Maternal Mortality Rate Risk Adjustment Universal Health Coverage Abdominal Emergency Continuous Quality Improvement Process 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.


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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • David A. Watters
    • 1
  • Michael J. Hollands
    • 2
  • Russell L. Gruen
    • 3
  • Kiki Maoate
    • 4
  • Haydn Perndt
    • 5
  • Robert J. McDougall
    • 6
  • Wayne W. Morriss
    • 7
  • Viliami Tangi
    • 8
  • Kathleen M. Casey
    • 9
  • Kelly A. McQueen
    • 10
  1. 1.Deakin University and Barwon HealthRoyal Australasian College of SurgeonsMelbourneAustralia
  2. 2.Royal Australasian College of SurgeonsMelbourneAustralia
  3. 3.Royal Australasian College of SurgeonsNational Trauma Research InstituteMelbourneAustralia
  4. 4.Children’s Specialist CentreChristchurchNew Zealand
  5. 5.School of Medicine, Royal Hobart HospitalThe University of TasmaniaHobartAustralia
  6. 6.The Royal Children’s Hospital MelbourneMelbourneAustralia
  7. 7.Christchurch HospitalChristchurchNew Zealand
  8. 8.Ministry of HealthNuku’alofaTonga
  9. 9.American College of SurgeonsChicagoUSA
  10. 10.Vanderbilt University Medical CentreNashvilleUSA

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