Study: 50 million patients suffer postop complications worldwide, 1.5 million die

A new study found that out of the 310 million surgery patients who receive surgery every year, 50 million suffer postoperative complications and more than 1.5 million die from those complications. Surprisingly, patients in low- and middle-income countries were less likely to experience complications than those in high-income nations.

The study was the first of its kind at the international level, and was conducted by the International Surgical Outcomes Study Group, led by Queen Mary University of London's Professor Rupert Pearse and published in the British Journal of Anaesthesia (BJA). Researchers used data on 44,814 patients who underwent surgery within the same seven-day period, comparing different types of surgery with the frequency and severity of adverse outcomes. The patients came from 474 different hospitals in 27 different countries, ranging between high income (U.S., U.K., Germany) and low income (Uganda, Brazil, Romania.)

In a press release, Pearse called on hospitals worldwide to work towards reducing preventable complications.

"There is still a great deal of work to be done to improve patient care around the time of surgery,” he said. “Initiatives such as that led by the Royal College of Anaesthetists Perioperative Medicine programme provide excellent examples of what can be done to resolve these problems."

On average, 16.8% of all patients experienced a complication after surgery and 2.8% subsequently died without leaving the hospital. However, only 11% of patients in low- and middle-income countries experienced complications compared to 19% in high-income countries. Researchers theorize that the difference may be because high-income nations offer surgery to higher-risk patients who are older, frailer, or have long-term diseases like diabetes or heart failure. However, mortality rates are pretty similar globally. If a patient experiences a complication in a rich country, there odds of survival are only 0.7% better than if they were in a low-/middle-income country (2.6% vs. 3.3%.)

“These statistics beg the question of whether the right patients are being admitted to critical care,” researchers wrote. “And if more lives could be saved if the criteria for critical care were reassessed.”
The most common surgical complication in the world are infectious complications, particularly superficial site infections, which affect 28 million (9%) patients. Meanwhile, cardiovascular complications affect 4.5% of all patients and have the highest risk of mortality. Upper gastrointestinal surgeries run the greatest risk of complications and orthopedics and breast procedures are the least risky.

"These findings should serve as a wake-up call,” says BJA editor-in-chief Ravi Majahan. “We need to do more to prevent postsurgery complications—and particularly complications such as infection which are in many cases preventable, but as this research suggests are claiming the lives of three quarters of a million people worldwide, every year."