Perioperative Mortality Rate (POMR): A Global Indicator of Access to Safe Surgery and Anaesthesia
- 1.1k Downloads
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.
KeywordsMaternal Mortality Rate Risk Adjustment Universal Health Coverage Abdominal Emergency Continuous Quality Improvement Process
Conflict of interest
The authors have no conflicts of interest or financial ties to disclose.
- 10.United Nations, Technical Support Team: Health and Sustainable Development. http://sustainabledevelopment.un.org/index.php?menu=1549. Accessed July 2013
- 11.POMRC 2011, Perioperative Mortality in New Zealand. Inaugural report of the perioperative mortality review committee, Wellington, Health Quality and Safety Commission. http://www.hqsc.govt.nz/assets/POMRC/Publications/POMRC-2011-Report-Lkd.pdf. Accessed February 2012
- 12.Watters DA (2013) Access to safe surgery and anaesthesia when needed. Surgical News 2013:12–13. Royal Australasian College of Surgeons, Melbourne. www.surgeons.org/media/…/art_2013-05-15_surgical_news_may.pdf. Accessed July 2013Google Scholar
- 13.World Alliance for Patient Safety. Global patient safety challenge 2007–08: Safe Surgery Saves Lives, 2007. World Health Organisation, Geneva. http://www.who.int/patientsafety/challenge/safe.surgery/en/. Accessed July 2013
- 15.Dripps RD (1963) New classification of physical status. Anaesthesiology 24:111Google Scholar
- 21.Perioperative Mortality Review Committee (2012) Perioperative Mortality in New Zealand, Second Report of the Perioperative Review Committee, Wellington: Health Quality and Safety CommissionGoogle Scholar
- 40.Clinical Excellence Commission (CEC) (2012) Activities of the Special Committee Investigating Deaths under Anaesthesia—2010. CEC, SydneyGoogle Scholar
- 45.Paiva H (2003) Perioperative Mortality in Papua New Guinea. MMed Thesis, University of Papua New GuineaGoogle Scholar
- 47.Inbasegaran K, Kandasami P, Sivalingam N (1998) A 2-year audit of perioperative mortality in Malaysian hospitals. Med J Malays 53:334–342Google Scholar
- 54.Gibbs N, Rodoreda P (2005) Anaesthetic mortality rates in Western Australia 1980–2002. Anaesth Intens Care 33:616–622Google Scholar