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Perioperative mortality rate (POMR): A global indicator of access to safe surgery and anaesthesia

Citation

Walters, DA and Hollands, MJ and Gruen, RL and Maoate, K and Perndt, H and McDougall, RJ and Morriss, WW and Tangi, V and Casey, KM and McQueen, KA, Perioperative mortality rate (POMR): A global indicator of access to safe surgery and anaesthesia, World Journal of Surgery, 39, (4) pp. 856-864. ISSN 0364-2313 (2015) [Refereed Article]

Copyright Statement

Copyright Socie´te´ Internationale de Chirurgie 2014

DOI: doi:10.1007/s00268-014-2638-4

Abstract

Introduction: The unmet global burden of surgical disease is substantial. Currently, two billion people do not have access to emergency and essential surgical care. This results in unnecessary deaths from injury, infection, complications of pregnancy, and abdominal emergencies. Inadequately treated surgical disease results in disability, and many children suffer deformity without corrective surgery.

Methods: A consensus meeting was held between representatives of Surgical and Anaesthetic Colleges and Societies to obtain agreement about which indicators were the most appropriate and credible. The literature and state of national reporting of perioperative mortality rates was reviewed by the authors.

Results: There is a need for a credible national and/or regional indicator that is relevant to emergency and essential surgical care. We recommend introducing the perioperative mortality rate (POMR) as an indicator of access to and safety of surgery and anaesthesia. POMR should be measured at two time periods: death on the day of surgery and death before discharge from hospital or within 30 days of the procedure, whichever is sooner. The rate should be expressed as the number of deaths (numerator) over the number of procedures (denominator). The option of before-discharge or 30 days is practical for those low- to middle-income countries where postdischarge follow-up is likely to be incomplete, but it allows those that currently can report 30-day mortality rates to continue to do so. Clinical interpretation of POMR at a hospital or health service level will be facilitated by risk stratification using age, urgency (elective and emergency), procedure/procedure group, and the American Society of Anesthesiologists grade.

Conclusions: POMR should be reported as a health indicator by all countries and regions of the world. POMR reporting is feasible, credible, achieves a consensus of acceptance for reporting at national level. Hospital and Service level POMR requires interpretation using simple measures of risk adjustment such as urgency, age, the condition being treated or the procedure being performed and ASA status.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Clinical Sciences
Research Field:Surgery
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Surgical Methods and Procedures
Author:Perndt, H (Dr Haydn Perndt)
ID Code:106684
Year Published:2015
Web of Science® Times Cited:27
Deposited By:Medicine (Discipline)
Deposited On:2016-02-17
Last Modified:2017-11-01
Downloads:0

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