Perioperative Mortality Rate (POMR): A Global Indicator of Access to Safe Surgery and Anaesthesia

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• 作者：David A. Watters (1)
  Michael J. Hollands (2)
  Russell L. Gruen (3)
  Kiki Maoate (4)
  Haydn Perndt (5)
  Robert J. McDougall (6)
  Wayne W. Morriss (7)
  Viliami Tangi (8)
  Kathleen M. Casey (9)
  Kelly A. McQueen (10)
  
  1. Deakin University and Barwon Health ; Royal Australasian College of Surgeons ; 1 Spring Street ; Melbourne ; VIC ; 3000 ; Australia
  2. Royal Australasian College of Surgeons ; 1 Spring Street ; Melbourne ; VIC ; 3000 ; Australia
  3. Royal Australasian College of Surgeons ; National Trauma Research Institute ; Level 4 ; 89 Commercial Road ; Melbourne ; VIC ; Australia
  4. Children鈥檚 Specialist Centre ; 58 Colombo Street ; Cashmere ; Christchurch ; New Zealand
  5. School of Medicine ; Royal Hobart Hospital ; The University of Tasmania ; GPO Box 1061 L ; Hobart ; TAS ; Australia
  6. The Royal Children鈥檚 Hospital Melbourne ; Flemington Road ; Parkville ; Melbourne ; VIC ; Australia
  7. Christchurch Hospital ; Riccarton Avenue ; Addington ; Christchurch ; New Zealand
  8. Ministry of Health ; Taufa鈥檃hau Road ; Nuku鈥檃lofa ; Tonga
  9. American College of Surgeons ; 633 N. Saint Clair Street ; Chicago ; IL ; USA
  10. Vanderbilt University Medical Centre ; 1211 Medical Centre Drive ; Nashville ; TN ; USA
  
• 刊名：World Journal of Surgery
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：39
• 期：4
• 页码：856-864
• 全文大小：207 KB
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• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Abdominal Surgery
  Cardiac Surgery
  General Surgery
  Thoracic Surgery
  Vascular Surgery
  
• 出版者：Springer New York
• ISSN：1432-2323

文摘

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.