哥伦比亚外科成果研究对围术期死亡率(全球外科 Lancet 委员会的一项主要指标)的见解--一项前瞻性队列研究

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Americas Pub Date : 2024-08-20 DOI:10.1016/j.lana.2024.100862
Carlos J. Pérez Rivera , Nicolás Lozano-Suárez , Alejandro Velandia-Sánchez , Maria Paula Vargas-Cuellar , Luisa Fernanda Rojas-Serrano , Camilo A. Polanía-Sandoval , Daniela Lara-Espinosa , Laura García-Zambrano , Maria Paz Bohórquez-Tarazona , Silvia Valentina Agudelo-Mendoza , Paulo A. Cabrera-Rivera , Leonardo Briceno-Ayala
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引用次数: 0

摘要

背景手术护理在医疗保健中具有重要意义,尤其是在中低收入国家,因为在手术后最初 30 天内死亡的 420 万人中,至少有 50%发生在这些国家。柳叶刀全球外科委员会提出了加强外科护理的六项指标。哥伦比亚利用二手数据进行了研究。然而,降低围手术期死亡率的策略尚未实施。本研究旨在利用哥伦比亚的原始数据描述第四项指标--围手术期死亡率(POMR)。方法 在哥伦比亚的 54 家中心(医院)开展了一项多中心前瞻性队列研究。每个中心在 2022 年 5 月 5 日至 2023 年 1 月 1 日之间选择了一个为期 7 天的招募期。纳入标准包括在手术室接受外科手术的 18 岁以上患者。研究结果3807名患者的中位年龄为48岁(IQR为32-64),80.3%的患者被归类为ASA I级或II级,27%的手术复杂程度较低。主要手术为骨科(19.2%)和妇产科(17.7%)。根据克拉维恩-丁多评分法,术后并发症分为主要并发症(11.7%,10.68-12.76)和任何并发症(31.6%,30.09-33.07)。POMR为1.9%(1.48-2.37),择期手术和急诊手术死亡率分别为0.7%(0.40-1.23)和3%(2.3-3.89)。本研究是公共卫生领域的重大进展,为国家决策者提高手术护理质量提供了有价值的见解。本文由罗萨里奥大学(Universidad del Rosario)和Fundación Cardioinfantil-Instituto de Cardiología基金资助,基金号为CTO-057-2021,项目编号为IV-FGV017。
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Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery – a prospective cohort study

Background

Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia.

Methods

A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions.

Findings

3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively.

Interpretation

The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care.

Funding

This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.

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期刊介绍: The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.
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