高、中、低收入国家急诊腹部手术的死亡率。

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

出版信息

Br J Surg. 2016 Jul;103(8):971-988. doi: 10.1002/bjs.10151. Epub 2016 May 4.

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).

摘要

背景

高收入国家常规收集外科手术死亡率数据，但几乎没有中低收入国家进行外科手术后的结果监测。本研究旨在前瞻性收集全球范围内急诊腹部手术后的死亡率数据，并比较不同人类发展指数（HDI）的国家的发现。

方法

这是一项前瞻性、多中心、队列研究。自我选择的进行急诊手术的医院在 2014 年 7 月至 12 月的至少两周时间内，为至少一个 2 周间隔内的连续患者提交预先指定的数据。术后死亡率采用分层多变量逻辑回归进行分析。

结果

从 58 个国家的 357 个中心获得了 10745 名患者的数据；6538 例来自高收入国家，2889 例来自中收入国家，1318 例来自低收入国家。24 小时内的总体死亡率为 1.6%（高收入国家为 1.1%，中收入国家为 1.9%，低收入国家为 3.4%；P<0.001），30 天内死亡率增加至 5.4%（高收入国家为 4.5%，中收入国家为 6.0%，低收入国家为 8.6%；P<0.001）。在 578 名死亡患者中，有 404 名（69.9%）在手术后 24 小时至 30 天内死亡（高收入国家为 74.2%，中收入国家为 68.8%，低收入国家为 60.5%）。调整后，中收入国家（比值比（OR）2.78，95%置信区间（CI）1.84 至 4.20）和低收入国家（OR 2.97，1.84 至 4.81）的 30 天死亡率仍然较高。手术安全检查表在中低收入国家的使用频率较低，但使用时与 30 天死亡率降低相关。