Posted Tuesday February 5, 2019

Risk of Death & income

More people die after surgery worldwide than from HIV, TB, and malaria combined

Around the world, 4.2 million people die every year within 30 days of surgery, and this translates to the third leading cause of death worldwide, a new study reveals

Since 50 per cent of these deaths occur in low- and middle-income countries, where surgery is less accessible, it reveals the disproportionate burden of postoperative death globally. While risk of dying is related to the type of procedure, on average, the risk was twice as great in lower income countries than high-income countries.

Researchers at Western University in collaboration with the University of Birmingham and University of Cape Town published their global analysis on the risk of dying within 30 days of surgery in a research letter to The Lancet. They estimate that more people die each year within 30 days post-surgery than from HIV, tuberculosis, and malaria combined (2.97 million).

“This study answers a question that’s never been asked before – where does post-operative mortality rank in terms of overall global causes of death?” said Janet Martin, PharmD, Associate Professor at Western’s Schulich School of Medicine & Dentistry and Director of the Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), a co-author on the paper. “The finding that more people die each year within 30 days of surgery than from the big three global burdens of disease, means that if we put more focus on improving safety of surgery worldwide, we can potentially save many more lives.”

There is also a significant unmet need for surgery in low- and middle-income countries and researchers believe that if operations were provided for all patients who need them before adequately implementing adequate safety and quality measures, the number of global post-operative deaths might further increase to 6.1 million.

The researchers analysed available information to estimate how many people around the world die after operations - based on surgical volume, case-mix and post-operative death rates adjusted for country income.

The Lancet Commission on Global Surgery identified that 313 million surgical procedures are performed each year, but little is known about the quality of surgery globally, as robust postoperative death rates are available for only 29 countries.

Dmitri Nepogodiev, Research Fellow at the University of Birmingham, is the primary author on the paper. “Surgery has been the 'neglected stepchild' of global health and has received a fraction of the investment put in to treating infectious diseases such as malaria,” he said.

At Western’s Schulich School of Medicine & Dentistry, Martin is leading a World Health Organization (WHO) Collaborating Centre that has the specific task of studying access to safe surgery, anesthesia, and perioperative care on the global stage.

The team at Schulich Medicine & Dentistry is the first collaborating centre to be designated by the WHO to address this complex surgical and perioperative care problem. They are working to understand the gaps in resources, capacity, infrastructure and training in countries around the globe in order to develop evidence-based priorities toward universal safe and effective essential surgery and anesthesia.

At present, around 4.8 billion people worldwide lack timely access to safe and affordable surgery and it is estimated that there is an annual unmet need for 143 million procedures in low- and middle- income countries.

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