Perioperative care may reduce Death after Surgery in low mid
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Cancer prevalence and its associated mortality are increasing in low-income and middle-income countries (LMICs). In a recent study, researchers have found higher levels of mortality after cancer surgery in LMICs than in upper-middle-income countries (UMICs). They noted that the mortality rate is not fully explained by stages of the disease and recommend policies that strengthen perioperative care systems.

Researchers compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality.

This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anesthesia. The primary outcome was death or major complication within 30 days of surgery.

Investigators enrolled 15958 patients from 428 hospitals in 82 countries.

--Patients in LMICs presented with more advanced disease compared with patients in high-income countries.

--30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries and for colorectal cancer in low-income or lower-middle-income countries and upper-middle-income countries.

--No difference in 30-day mortality was seen in breast cancer.

--The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries and upper-middle-income countries.

--Postoperative death after complications was partly explained by patient factors and partly by hospital or country.

--The absence of consistently available postoperative care facilities was associated with 7 to 10 more deaths per 100 major complications in LMICs. The cancer stage alone explained little of the early variation in mortality or postoperative complications.

Conclusively, higher levels of mortality after cancer surgery in LMICs were not fully explained by later presentation of the disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications.

Source: https://doi.org/10.1016/S0140-6736(21)00001-5
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