Global surgical guidelines drive cut in post-surgery deaths - study

The English National Health Service (NHS) reduced post-operative deaths by 37.2% following the introduction of globally recognised surgical guidelines – paving the way for life-saving action in low- and middle-income countries (LMICs), a new study reveals.

Researchers at the University of Birmingham have confirmed that the NHS achieved the reduction between 1998 and 2014, coinciding with the introduction of the World Health Organisation (WHO) Surgical Safety Checklist in 2008.

Investigation of data showed a consistent downward trend over the 16-year period, with the greatest reductions achieved in oesophagogastric (68.8%) and breast (69.3%) surgery.

The researchers published their analysis on the reduction of postoperative mortality rates (POMR) in a research letter to British Journal of Surgery. Their findings echo the results of similar research into NHS Scotland for the period 2000 to 2014, which found that the WHO Checklist was a key driver in POMR by 39%.

Mr Aneel Bhangu, Senior Lecturer at the University of Birmingham, commented: “Around the world 4.2 million people die every year within 30 days after surgery – with half of these deaths occurring in LMICs. Identification of strategies to reduce postoperative mortality is now a global research priority.

“It is encouraging that despite having among the lowest baseline rates globally, both Scotland and England have achieved a greater than one-third reduction in overall POMR. Replicating these gains internationally could avoid thousands of postoperative deaths, with the greatest potential gains in LMICs.”

He added that the checklist was essential part of improving perioperative safety, although variable reductions in deaths across specialties suggested that procedure specific initiatives have made a major contribution to reducing overall POMR.

Researchers at the University’s NIHR Global Health Research Unit on Global Surgery replicated the analysis of NHS Scotland performance using publicly available inpatient POMR data. They discovered a 37.2% relative reduction (1.21 to 0.76%) in overall inpatient POMR.

The study followed the Unit’s research, published earlier this year in The Lancet, which discovered the figure of 4.2 million deaths every year within 30 days after surgery.

There is also a significant unmet need for surgery in LMICs and researchers believe that if operations were provided for all patients who need them the number of global post-operative deaths would increase to 6.1 million.

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 LMICs.

• The University of Birmingham is ranked amongst the world’s top 100 institutions, its work brings people from across the world to Birmingham, including researchers and teachers and more than 6,500 international students from over 150 countries.
• The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

 Funds, supports and delivers high quality research that benefits the NHS, public health and social care
 Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
 Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
 Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
 Partners with other public funders, charities and industry to maximise the value of research to patients and the economy

• The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.
• NIHR funder the NIHR Global Health Research Unit on Global Surgery built capacity and sustainable surgical research infrastructures in partner LMICs. The Unit working closely together with its UK and LMIC partners to deliver research studies and disseminate the findings. For the current 2019 fiscal year, the World Bank defines low-income economies as those with a GNI per capita, calculated using the World Bank Atlas method, of $995 or less in 2017; lower middle-income economies are those with a GNI per capita between $996 and $3,895; upper middle-income economies are those with a GNI per capita between $3,896 and $12,055; high-income economies are those with a GNI per capita of $12,056 or more.