Surgeon Volume and Established Hospital Perioperative Mortality Rate Together Predict Superior Outcomes After Open AAA Repair

Abstract OBJECTIVES Globally congenital heart disease mortality is declining, yet the proportion of infant deaths attributable to heart disease rises in Colombia and other middle-sociodemographic countries. We aimed to assess the accessibility of paediatric cardiac surgery (PCS) to children <18 years of age in 2016 in the South American country of Colombia. METHODS In Bogotá, Colombia, a multi-national team used cross-sectional and retrospective cohort study designs to adapt and evaluate 4 health system indicators at the national level: first, the population with timely geographic access to an institution providing PCS; second, the number of paediatric cardiac surgeons; third, this specialized procedure volume and its national distribution; and fourth, the 30-day perioperative mortality rate after PCS in Colombia. RESULTS Geospatial mapping approximates 64% (n = 9 894 356) of the under-18 Colombian population lives within 2-h drivetime of an institution providing PCS. Twenty-eight cardiovascular surgeons report performing PCS, 82% (n = 23) with formal training. In 2016, 1281 PCS procedures were registered, 90% of whom were performed in 6 of the country’s 32 departments. National non-risk-adjusted all-cause 30-day perioperative mortality rate after PCS was 2.73% (n = 35). CONCLUSIONS Colombia’s paediatric population had variable access to cardiac surgery in 2016, largely dependent upon geography. While the country may have the capacity to provide timely, high-quality care to those who need it, our study enables future comparative analyses to measure the impact of health system interventions facilitating healthcare equity for the underserved populations across Colombia and the Latin American region.

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Monitoring and evaluating surgical care: defining perioperative mortality rate and standardising data collection

The Lancet ◽

10.1016/s0140-6736(15)60822-4 ◽

2015 ◽

Vol 385 ◽

pp. S27 ◽

Cited By ~ 12

Author(s):

Charlotta L Palmqvist ◽

Roshan Ariyaratnam ◽

David A Watters ◽

Grant L Laing ◽

Douglas Stupart ◽

...

Keyword(s):

Mortality Rate ◽

Data Collection ◽

Surgical Care ◽

Perioperative Mortality

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Perioperative Mortality Rate (pomr) in a Low-resource Non-governmental Organization (ngo) Hospital Setting in India.

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2021.08.229 ◽

2021 ◽

Vol 233 (5) ◽

pp. e86

Author(s):

Yuki J. Ng ◽

Ravindranath M. Shroff

Keyword(s):

Mortality Rate ◽

Hospital Setting ◽

Perioperative Mortality ◽

Governmental Organization ◽

Low Resource

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Pediatric Perioperative Mortality in Kenya

Anesthesiology ◽

10.1097/aln.0000000000003070 ◽

2020 ◽

Vol 132 (3) ◽

pp. 452-460 ◽

Cited By ~ 3

Author(s):

Mark W. Newton ◽

Savannah E. Hurt ◽

Matthew D. McEvoy ◽

Yaping Shi ◽

Matthew S. Shotwell ◽

...

Keyword(s):

Mortality Rate ◽

Pediatric Surgery ◽

Surgical Care ◽

Perioperative Mortality ◽

Middle Income ◽

Factors Associated ◽

Safe Surgery ◽

Low Middle Income Countries ◽

Care Systems ◽

Data Elements

Abstract Background The global surgery access imbalance will have a dramatic impact on the growing population of the world’s children. In regions of the world with pediatric surgery and anesthesia manpower deficits and pediatric surgery–specific infrastructure and supply chain gaps, this expanding population will present new challenges. Perioperative mortality rate is an established indicator of the quality and safety of surgical care. To establish a baseline pediatric perioperative mortality rate and factors associated with mortality in Kenya, the authors designed a prospective cohort study and measured 24-h, 48-h, and 7-day perioperative mortality. Methods The authors trained anesthesia providers to electronically collect 132 data elements for pediatric surgical cases in 24 government and nongovernment facilities at primary, secondary, and tertiary hospitals from January 2014 to December 2016. Data assistants tracked all patients to 7 days postoperative, even if they had been discharged. Adjusted analyses were performed to compare mortality among different hospital levels after adjusting for prespecified risk factors. Results Of 6,005 cases analyzed, there were 46 (0.8%) 24-h, 62 (1.1%) 48-h, and 77 (1.7%) 7-day cumulative mortalities reported. In the adjusted analysis, factors associated with a statistically significant increase in 7-day mortality were American Society of Anesthesiologists Physical Status of III or more, night or weekend surgery, and not having the Safe Surgery Checklist performed. The 7-day perioperative mortality rate is less in the secondary (1.4%) and tertiary (2.4%) hospitals when compared with the primary (3.7%) hospitals. Conclusions The authors have established a baseline pediatric perioperative mortality rate that is greater than 100 times higher than in high-income countries. The authors have identified factors associated with an increased mortality, such as not using the Safe Surgery Checklist. This analysis may be helpful in establishing pediatric surgical care systems in low–middle income countries and develop research pathways addressing interventions that will assist in decreasing mortality rate. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Postoperative mortality in parathyroid surgery in Sweden during five decades: improved outcome despite older patients

Acta Endocrinologica ◽

10.1530/eje-08-0523 ◽

2009 ◽

Vol 160 (2) ◽

pp. 295-299 ◽

Cited By ~ 9

Author(s):

S Norenstedt ◽

A Ekbom ◽

L Brandt ◽

J Zedenius ◽

I-L Nilsson

Keyword(s):

Mortality Rate ◽

Elderly Patients ◽

Mortality Risk ◽

Age Groups ◽

Postoperative Mortality ◽

Premature Death ◽

Safe Procedure ◽

Parathyroid Surgery ◽

Perioperative Mortality ◽

Swedish Population

ObjectivePrimary hyperparathyroidism (pHPT) is a common endocrine disorder. In Europe, pHPT has been associated with premature death in cardiovascular disorders. Our question was whether the risk of postoperative death has been affected by the increased proportion of elderly patients referred for parathyroid surgery.MethodsThe nationwide Cancer Registry and Causes-of-Death Registry were used to analyze mortality among 14 635 Swedish patients subjected to parathyroid adenomectomy (PTx) during 1961–2004. Standard mortality ratios (SMR) and the 95% confidence intervals (CI) were calculated with the entire Swedish population as control, standardized for age, gender and calendar year.ResultsThe observation period was more than 166 000 person-years. The overall perioperative (30-day) mortality rate was 1.3% (185/14 635; SMR 7.9; CI 6.82–9.15); 1.1% for women (132/11 500; SMR 7.56; CI 6.32–8.96), and 1.7% for men (53/3135; SMR 9.01; CI 6.75–11.78). Cardiovascular disorder was the dominant cause of death in both sexes and in all the investigated age groups (age 15–54 years; SMR 29.0; CI 9.42–67.71, age 55–74 years; SMR 6.12; CI 3.96–9.03, age 75 years: SMR 5.26; CI 3.74–7.19). The SMR decreased over the calendar year period notwithstanding a rising proportion of elderly individuals. In the most recent period, 1997–2004, the perioperative mortality rate was only 0.5%, which represents a normalization of the excess mortality risk during the first post-PTx year (SMR 1.17; CI 0.92–1.46).ConclusionPTx is a safe procedure, regardless of patient age. Today, the perioperative mortality risk is not a reason for excluding elderly patients from parathyroid surgery.

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Toward a standard approach to measurement and reporting of perioperative mortality rate as a global indicator for surgery

Surgery ◽

10.1016/j.surg.2015.03.024 ◽

2015 ◽

Vol 158 (1) ◽

pp. 17-26 ◽

Cited By ~ 31

Author(s):

Roshan Ariyaratnam ◽

Charlotta L. Palmqvist ◽

Phil Hider ◽

Grant L. Laing ◽

Douglas Stupart ◽

...

Keyword(s):

Mortality Rate ◽

Standard Approach ◽

Perioperative Mortality ◽

Global Indicator

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A Three-year Retrospective Study of Perioperative Mortality at a Tertiary Children Hospital in Iran

10.21203/rs.3.rs-48560/v1 ◽

2020 ◽

Author(s):

mohammad gharavifard ◽

majid sharifian

Keyword(s):

Retrospective Study ◽

Mortality Rate ◽

Pediatric Population ◽

Tertiary Hospital ◽

Mean Value ◽

Time Interval ◽

Perioperative Mortality ◽

Post Surgery ◽

Duration Of Surgery ◽

Type Of Surgery

Abstract Introduction: Mortality is a key criterion for quality and safety in surgery. Studies show the higher rate of perioperative mortality in children compared with adults. The aim of present study was to determine the mortality rate after surgery among pediatric population. Methods: This retrospective study of perioperative mortality rate was performed in children younger than 18 years who operated at surgery unit of Dr. Sheikh pediatric tertiary hospital, Iran. Records of all cases of pediatric surgery performed under anesthesia between March 2015 and March 2018 were reviewed. Mortality rate at different time intervals after surgery, demographic characteristics and comorbidities of patients, type and duration of surgery, the number of operations in each child, the time interval between surgery and death, and the emergency level of surgery were recorded. Chi-square test was used for analysis of results. Results: Out of 5,5027 surgeries, 214 deaths were recorded, 78.6% of which occurred within one month after surgery. Mortality rate per 10,000 surgeries in the first year was about 49, which dropped to 10 in the third year. The mean value of mortality within 30-day post-surgery was 27.44 per 10000 procedures. The highest mortality rate was observed in people under 3 years of age with 67.2% and in females with 52.8%. Cardiac disease was at the top of comorbidities among dead patients. There was significant relationship between age and type of surgery with time interval between surgery and death. Conclusion: Infant age group and type of surgery was the main predictor of perioperative mortality.

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