CITATION: Mechanisms and causes of death after abdominal surgery in low-income and middle-income countries: a secondary analysis of the FALCON trial
Kamarajah, Sivesh et al. The Lancet Global Health, Volume 12, Issue 11, e1807 - e1815
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(24)00318-8/fulltext
Summary
Background: Death after surgery is devasting for patients, families, and communities, but remains common in low-income and middle-income countries (LMICs). We aimed to use high-quality data from an existing global randomised trial to describe the causes and mechanisms of postoperative mortality in LMICs. To do so, we developed a novel framework, learning from both existing classification systems and emerging insights during data analysis...
Interpretation: Circulatory failure leads to most deaths after abdominal surgery, with sepsis accounting for almost two-thirds. Variability in timing of death highlights opportunities to intervene throughout the perioperative pathway, including after hospital discharge. A high proportion of patients without a clear cause of death reflects the need to improve capacity to rescue and cure by strengthening perioperative systems...
Implications of all the available evidence
Death after surgery in LMICs is multifactorial, with an interplay between severity of disease at presentation, cause, timing, and location. Reducing deaths after surgery in LMICs primarily requires intervention to address circulatory failure and sepsis. Focus is required both in hospital and outside hospital (since one in five postoperative deaths occur outside hospital). Design of interventions is likely to be complex and cannot be overburdensome to already stretched clinical services
COMMENT (NPW): It is only by reading the full text that one finds perhaps the most important point of all: 'The quality of surgical care in the perioperative period plays an important role in reducing deaths after surgery globally, especially in LMICs. Unlike in high-income countries, there is little to no high-quality evidence in LMICs showing implementation and adherence to high-quality care pathways for patients. This lack of high-quality pathways results in failure to provide timely access to services, deliver safe care, and rescue patients from postoperative complications. Therefore, almost 5 billion patients cannot access safe, affordable, and timely surgical care.'
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
