Tarsicio Uribe?Leitz|BA Joshua Jaramillo|Lydia R. Maurer|BE Rui Fu|Micaela Esquivel|Atul A. Gawande|Alex B. Haynes|Thomas Weiser
Variability in mortality following caesarean delivery, appendectomy, and groin hernia repair in low-income and middle-income countries: a systematic review and analysis of published data
Stanford Medicine|Stanford University|Stanford University|Stanford University|Stanford Medicine|Brigham and Women's Hospital|Massachusetts General Hospital|Ariadne Diagnostics (United States)|Stanford Medicine
backgroundsurgical interventions occur lower rates resourcepoor settings complication death rates following surgery probably substantial well quantified deeper understanding outcomes crucial step ensure high quality accompanies increased global access surgical care aimed assess surgical mortality following three common surgical procedurescaesarean delivery appendectomy groin inguinal femoral hernia repairto quantify potential risks expanding access without simultaneously addressing issues quality safetymethodswe collected demographic health economic data 113 countries classified low income lowermiddle income world bank 2005 systematic review ovid medline pubmed scopus jan 1 2000 jan 15 2015 identify studies countries reporting allcause mortality following three commonly undertaken operations reports governmental agencies also identified included modelled surgical mortality rates countries without reported data using twostep multiple imputation method first used fully conditional specification fcs multiple imputation method establish complete datasets missing variables considered potentially predictive surgical mortality used regressionbased predictive mean matching imputation methods specified within multiple imputation fcs method selected predictors operation using completed dataset predict mortality rates along confidence intervals countries without reported mortality data account variability data availability aggregated results subregion estimated surgical mortality ratesfindingsfrom initial 1302 articles reports identified 247 fulltext articles met inclusion criteria 124 provided data surgical mortality least one three selected operations identified 42 countries mortality data least one three procedures median reported mortality 79 per 1000 operations caesarean delivery iqr 28199 22 per 1000 operations appendectomy 00172 49 per 1000 operations groin hernia 00117 perioperative mortality estimates subregion ranged 28 south asia 502 east asia per 1000 caesarean deliveries 24 south asia 540 central subsaharan africa per 1000 appendectomies 03 andean latin america 255 southern subsaharan africa per 1000 hernia repairsinterpretationallcause postoperative mortality rates exceedingly variable within resourceconstrained environments efforts expand surgical access provision services must include strong commitment improve safety quality carefundingnone