Key result
Surgical procedures in Colombia were associated with an overall perioperative mortality rate of 1.9% (95% CI 1.48-2.37), with rates of 0.7% for elective and 3% for emergency surgeries.
Why the study?
Previous studies in Colombia relied on secondary data and strategies to reduce perioperative mortality had not been implemented, motivating this study to describe perioperative mortality rate with primary data.
Cohort (n=3,807)
Yes
The perioperative mortality rate in Colombia was 1.9%, higher than previously reported in national studies despite a low-risk patient profile.
Raises concerns for perioperative care quality in Colombia; leaves open contributions of unmeasured factors in this observational cohort.
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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Pérez-Rivera et al. (2024) conducted a cohort in Patients undergoing surgical procedures (n=3,807). Surgical procedures was evaluated on Perioperative mortality rate (POMR) (95% CI 1.48-2.37). Surgical procedures in Colombia were associated with an overall perioperative mortality rate of 1.9% (95% CI 1.48-2.37), with rates of 0.7% for elective and 3% for emergency surgeries.
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