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

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Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Lozano R, Naghavi M, Foreman K et al (2012) Global and regional mortality from 235 causes of death from 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease study 2010. Lancet 380:2095–2128

    Article  PubMed  Google Scholar 

  2. Murray CL, Voss T, Lozano R et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease study 2010. Lancet 380:2197–2223

    Article  PubMed  Google Scholar 

  3. Vos T, Flazman AD, Naghawi M et al (2012) Years lived with a disability (YLD) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the GBDS 2010. Lancet 380:2163–2196

    Article  PubMed  Google Scholar 

  4. Weiser TG, Regenbogen SE, Thompson K et al (2012) An estimation of the global volume of surgery: a modeling strategy based on available data. Lancet 372:139–144

    Article  Google Scholar 

  5. Mock C, Joshipura M, Arreola-Risa C et al (2012) An estimate of the number of lives that could be saved through improvements in trauma care globally. World J Surg 36:959–963. doi:10.1007/s00268-012-1459-6

    Article  PubMed  Google Scholar 

  6. Mock C (2013) Confronting the global burden of surgical disease. World J Surg 37:1457–1459. doi:10.1007/s00268-013-2102-x

    Article  PubMed  Google Scholar 

  7. Weiser TG, Makary MA, Haynes AB et al (2009) Standardised metrics for global surgical surveillance. Lancet 374:1113–1117

    Article  PubMed  Google Scholar 

  8. Linden AF, Sekidde FS, Galukande M et al (2012) Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda’s public hospitals. World J Surg 36:1056–1065. doi:10.1007/s00268-012-1482-7

    Article  PubMed  Google Scholar 

  9. Notrica MR, Evans FM, Knowlton LM et al (2011) Rwandan surgical and anesthesia infrastructure: a survey of district hospitals. World J Surg 35:1770–1780. doi:10.1007/s00268-011-1125-4

    Article  PubMed  Google Scholar 

  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 2013

  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

  14. Dripps RD, Lamont A, Eckenhoff JE (1961) The role of anesthesia in surgical mortality. JAMA 178:261–266

    Article  CAS  PubMed  Google Scholar 

  15. Dripps RD (1963) New classification of physical status. Anaesthesiology 24:111

    Google Scholar 

  16. Elixhauser A, Steiner C, Harris DR et al (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27

    Article  CAS  PubMed  Google Scholar 

  17. Charlson ME, Pompei PF, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  18. Owens WD, Felts JA, Spitznagel EL (1978) ASA physical status classification: a study of consistency of ratings. Anaesthesiology 49:239–243

    Article  CAS  Google Scholar 

  19. Davenport DL, Bowe EA, Henderson WG et al (2006) National Surgical Quality Improvement Program (NSQIP) risk factors can be used to validate American Society of Anesthesiologists Physical Status Classification (ASA PS) levels. Ann Surg 243:636–644

    Article  PubMed Central  PubMed  Google Scholar 

  20. Glance LG, Lustik SJ, Hannan EL et al (2012) The surgical mortality probability model. Derivation and validation of a simple risk prediction rule for noncardiac surgery. Ann Surg 255:696–702

    Article  PubMed  Google Scholar 

  21. Perioperative Mortality Review Committee (2012) Perioperative Mortality in New Zealand, Second Report of the Perioperative Review Committee, Wellington: Health Quality and Safety Commission

  22. Pearse RM, Moreno RP, Bauer P et al (2012) Mortality after surgery in Europe: a 7 day cohort study. Lancet 380:1059–1065

    Article  PubMed Central  PubMed  Google Scholar 

  23. Brodner G, Van Aken H (2013) Mortality after surgery in Europe. Lancet 381:370

    Article  PubMed  Google Scholar 

  24. Van Schalkwyk JM, Campbell D (2013) Mortality after surgery in Europe. Lancet 381:370

    Article  PubMed  Google Scholar 

  25. Franek E, Osinska B, Czech M et al (2012) Mortality after surgery in Europe. Lancet 381:369–370

    Article  Google Scholar 

  26. Mikstacki A (2013) Mortality after surgery in Europe. Lancet 381:369

    Article  PubMed  Google Scholar 

  27. Pupelis G, Vanags I (2013) Mortality after surgery in Europe. Lancet 381:369

    Article  PubMed  Google Scholar 

  28. Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. NEJM 360:491–499

    Article  CAS  PubMed  Google Scholar 

  29. de Vries EN, Hollmann MW, Smorenburg SM et al (2008) Development and validation of the surgical patient safety system (SURPASS) checklist. Qual Saf Health Care 18:121–126

    Article  Google Scholar 

  30. Bainbridge D, Martin J, Arango M et al (2012) Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. Lancet 380:1075–1081

    Article  PubMed  Google Scholar 

  31. Harris I, Madan A, Naylor J et al (2012) Mortality rates after surgery in New South Wales. ANZ J Surg 82:871–877

    Article  PubMed  Google Scholar 

  32. Beiles CB, Bourke B, Thomson I (2012) Results from the Australasian vascular surgical audit: the inaugural year. ANZ J Surg 199:105–111

    Article  Google Scholar 

  33. Gawande AA, Kwaan MR, Regenbogen SE et al (2007) An Apgar score for surgery. J Am Coll Surg 204:201–208

    Article  PubMed  Google Scholar 

  34. Vaid S, Bell T, Grim R et al (2012) Predicting risk of death in general surgery patients on the basis of preoperative variables using American College of Surgeons National Surgical Quality Improvement Program data. Perm J 16:10–17

    Article  PubMed Central  PubMed  Google Scholar 

  35. Kolfschoten NE, Marang van de Mheen PJ, Gooiker GA et al (2011) Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands. Eur J Surg Oncol 37:956–963

    Article  CAS  PubMed  Google Scholar 

  36. Haga Y, Wada Y, Takeuchi H et al (2012) Evaluation of modified estimation of physiologic ability and surgical stress in gastric carcinoma surgery. Gastric Cancer 15:7–14

    Article  PubMed  Google Scholar 

  37. Jairath V, Kahan BC, Logan RF et al (2012) National audit of the use of surgery and radiological embolization after failed endoscopic haemostasis for non-variceal upper gastrointestinal bleeding. Br J Surg 99:1672–1680

    Article  CAS  PubMed  Google Scholar 

  38. Liu SS, Della Valle AG, Besculides MC et al (2009) Trends in mortality, complications, and demographics for primary hip athroplasty in the United States. Int Orthop 33:643–651

    Article  PubMed Central  PubMed  Google Scholar 

  39. Watters DA, Bem C, Echun DA et al (1991) Audit of ‘surgery in general’ in an African teaching hospital. J R Coll Surg Edinb 36:402–404

    CAS  PubMed  Google Scholar 

  40. Clinical Excellence Commission (CEC) (2012) Activities of the Special Committee Investigating Deaths under Anaesthesia—2010. CEC, Sydney

    Google Scholar 

  41. Chu KM, Ford N, Trelles M (2010) Operative mortality in resource-limited settings. Arch Surg 145:721–725

    Article  PubMed  Google Scholar 

  42. Hansen D, Gausi SC, Merikebu M (2000) Anaesthesia in Malawi: complications and deaths. Trop Doct 30:146–149

    CAS  PubMed  Google Scholar 

  43. Ouro-bang’na Mamam AF, Tomta K, Ahouangbevi S et al (2005) Deaths associated with anaesthesia in Togo West Africa. Trop Doct 35:220–222

    Article  Google Scholar 

  44. McKenzie AG (1996) Mortality associated with anaesthesia at Zimbabwean teaching hospitals. S Afr Med J 86:338–342

    CAS  PubMed  Google Scholar 

  45. Paiva H (2003) Perioperative Mortality in Papua New Guinea. MMed Thesis, University of Papua New Guinea

  46. Heywood AJ, Wilson IH, Sinclair JR (1989) Perioperative mortality in Zambia. Ann R Coll Surg Engl 71:354–358

    PubMed Central  CAS  PubMed  Google Scholar 

  47. Inbasegaran K, Kandasami P, Sivalingam N (1998) A 2-year audit of perioperative mortality in Malaysian hospitals. Med J Malays 53:334–342

    CAS  Google Scholar 

  48. Thompson AM, Ashraf Z, Burton H et al (2005) Mapping changes in surgical mortality over 9 years by peer review audit. Br J Surg 92:1449–1452

    Article  CAS  PubMed  Google Scholar 

  49. Lunn JN (1998) The history and achievements of the National Confidential Enquiry into perioperative deaths. J Qual Clin Pract 18:29–35

    CAS  PubMed  Google Scholar 

  50. Derrington MC, Gallimore S (1997) The effect of the National Confidential Enquiry into perioperative deaths on clinical practice. Anaesthesia 52:3–8

    Article  CAS  PubMed  Google Scholar 

  51. Cain D, Ackland G (2012) Knowing the risk? NCEPOD 2011: a wake up call for perioperative practice. Br J Hosp Med 73:262–264

    Article  Google Scholar 

  52. North JB, Blackford FJ, Wall D et al (2013) Analysis of the causes and effects of delay before diagnosis using surgical mortality data. Br J Surg 100:419–425

    Article  CAS  PubMed  Google Scholar 

  53. Azzam DG, Neo CA, Itotoh FE et al (2013) The Western Australian audit of surgical mortality: outcomes from the first 10 years. Med J Aust 8:539–542

    Article  Google Scholar 

  54. Gibbs N, Rodoreda P (2005) Anaesthetic mortality rates in Western Australia 1980–2002. Anaesth Intens Care 33:616–622

    CAS  Google Scholar 

  55. Hodges SC, Mijumbi C, Okello M et al (2007) Anaesthesia services in developing countries: defining the problems. Anaesthesia 62:4–11

    Article  CAS  PubMed  Google Scholar 

  56. Merry AF, Cooper JB, Soyannwo O et al (2010) An iterative process of global quality improvement: the International Standards for a safe practice of anesthesia 2010. Can J Anaesth 57:1021–1026

    Article  PubMed Central  PubMed  Google Scholar 

  57. Merry AF, Cooper JB, Soyannwo O et al (2010) International standards for a safe practice of anesthesia 2010. Can J Anaesth 57:1027–1034

    Article  PubMed Central  PubMed  Google Scholar 

  58. Natuzzi ES, Kushner A, Jagilly R et al (2011) Surgical care in the Solomon Islands: a road map for universal surgical care delivery. World J Surg 35:1183–1193. doi:10.1007/s00268-011-1097-4

    Article  PubMed  Google Scholar 

  59. Gosselin RA, Thind A, Bellardinelli BA (2006) Cost/DALY averted in a small hospital in Sierra Leone: what is the relative contribution of different services? World J Surg 30:505–511. doi:10.1007/s00268-005-0609-5

    Article  PubMed  Google Scholar 

  60. Gosselin RA, Heitto M (2008) Cost-effectiveness of a district trauma hospital in Battambang, Cambodia. World J Surg 32:2450–2453. doi:10.1007/s00268-008-9708-4

    Article  PubMed  Google Scholar 

  61. Gosselin RA, Maldonado A, Elder G (2010) Comparative cost-effectiveness analysis of two MSF surgical trauma centres. World J Surg 34:415–419. doi:10.1007/s00268-009-0230-0

    Article  PubMed Central  PubMed  Google Scholar 

  62. Gosselin RA, Gialamas G, Atkin DM (2011) Comparing the cost-effectiveness of short orthopaedic missions in elective and relief situations in developing countries. World J Surg 35:951–955. doi:10.1007/s00268-010-0947-9

    Article  PubMed Central  PubMed  Google Scholar 

  63. Grimes CE, Henry JA, Maraka J et al (2014) Cost-effectiveness of surgery in low- and middle-income countries: a systematic review. World J Surg 38:252–263. doi:10.1007/s00268-013-2243-y

    Article  PubMed  Google Scholar 

  64. Shiffman J, Smith S (2007) Generation of political priority for global health initiatives: a framework and case study of maternal mortality. Lancet 370:1370–1379

    Article  PubMed  Google Scholar 

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Conflict of interest

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

Author information

Authors and Affiliations

  1. Deakin University and Barwon Health, Royal Australasian College of Surgeons, 1 Spring Street, Melbourne, VIC, 3000, Australia

    David A. Watters

  2. Royal Australasian College of Surgeons, 1 Spring Street, Melbourne, VIC, 3000, Australia

    Michael J. Hollands

  3. Royal Australasian College of Surgeons, National Trauma Research Institute, Level 4, 89 Commercial Road, Melbourne, VIC, Australia

    Russell L. Gruen

  4. Children’s Specialist Centre, 58 Colombo Street, Cashmere, Christchurch, New Zealand

    Kiki Maoate

  5. School of Medicine, Royal Hobart Hospital, The University of Tasmania, GPO Box 1061 L, Hobart, TAS, Australia

    Haydn Perndt

  6. The Royal Children’s Hospital Melbourne, Flemington Road, Parkville, Melbourne, VIC, Australia

    Robert J. McDougall

  7. Christchurch Hospital, Riccarton Avenue, Addington, Christchurch, New Zealand

    Wayne W. Morriss

  8. Ministry of Health, Taufa’ahau Road, Nuku’alofa, Tonga

    Viliami Tangi

  9. American College of Surgeons, 633 N. Saint Clair Street, Chicago, IL, USA

    Kathleen M. Casey

  10. Vanderbilt University Medical Centre, 1211 Medical Centre Drive, Nashville, TN, USA

    Kelly A. McQueen

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  1. David A. Watters
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  2. Michael J. Hollands
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  3. Russell L. Gruen
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Correspondence to David A. Watters.

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Watters, D.A., Hollands, M.J., Gruen, R.L. et al. Perioperative Mortality Rate (POMR): A Global Indicator of Access to Safe Surgery and Anaesthesia. World J Surg 39, 856–864 (2015). https://doi.org/10.1007/s00268-014-2638-4

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  • DOI: https://doi.org/10.1007/s00268-014-2638-4

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