Gastrointestinal surgery beyond tertiary centres: Experience from North Bengal, India

This is the authors' abstract. We don't add key points for this paper.

Contemporary data on the spectrum and outcomes of gastrointestinal surgery from non-metropolitan India are limited. This retrospective clinical audit characterised gastrointestinal surgery performed by a single specialist surgeon across public and private facilities in North Bengal, India, from January 2024 to December 2025. The source log contained 307 procedure components that were consolidated into 291 operative episodes; 255 (87.6%) were elective, 36 (12.4%) emergency and 221 (75.9%) were open procedures. Non-fatal Clavien-Dindo grade I-IV morbidity occurred after 56/291 episodes (19.2%; 95% CI 14.9%-24.3%), while 12 deaths occurred (4.1%; 95% CI 2.1%-7.1%); mortality was 2.0% after elective surgery and 19.4% after emergency surgery (crude risk ratio 9.9, 95% CI 3.3-29.6; Fisher exact p<0.001). The findings describe a heterogeneous non-metropolitan gastrointestinal surgical workload and show a marked unadjusted mortality difference by urgency, but they do not establish causal effects of facility type, resources, or service adaptations.