Patients in lower-HDI countries experienced higher mortality after trauma laparotomy despite lower injury severity (median ISS 9 vs 16) and less physiological derangement than in higher-HDI countries.
Highlights a critical global health disparity where trauma laparotomy mortality is higher in lower-HDI countries despite patients presenting with less severe injuries and physiological derangement.
Postoperative mortality is more common in the Global South than in wealthier, higher-resource health-care systems in the Global North. This has been shown in cancer,1 obstetrics,2 and now trauma. Most postoperative deaths globally occur due to bleeding or sepsis.3 In this issue of The Lancet Global Health, Michael F Bath and colleagues shed light on the epidemiology of death after trauma laparotomy in the GOAL-Trauma study.4 They highlight a higher rate of mortality in countries with a lower Human Development Index (HDI), despite patients being significantly less severely injured at the time of surgery (median Injury Severity Score: 9 lower-HDI countries vs 9 middle-HDI countries vs 16 higher-HDI countries), lower risk (American Society of Anesthesiologists grade 3–5: 33% vs 32% vs 48%), and less physiologically deranged (median lactate on arrival: 2·1 mmol/L vs 3·8 mmol/L vs 4·6 mmol/L).
Phelan et al. (Wed,) conducted a editorial in Trauma laparotomy. Lower Human Development Index (HDI) vs. Higher Human Development Index (HDI) was evaluated on Postoperative mortality. Patients in lower-HDI countries experienced higher mortality after trauma laparotomy despite lower injury severity (median ISS 9 vs 16) and less physiological derangement than in higher-HDI countries.