{"id":27026,"date":"2024-12-12T04:22:00","date_gmt":"2024-12-11T20:22:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=27026"},"modified":"2024-12-12T05:48:52","modified_gmt":"2024-12-11T21:48:52","slug":"lancet-global-health%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e4%b8%ad%e4%bd%8e%e6%94%b6%e5%85%a5%e5%9b%bd%e5%ae%b6%e8%85%b9%e9%83%a8%e6%89%8b%e6%9c%af%e5%90%8e%e6%ad%bb%e4%ba%a1%e7%9a%84","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=27026","title":{"rendered":"[Lancet Global Health\u53d1\u8868\u8bba\u6587]\uff1a\u4e2d\u4f4e\u6536\u5165\u56fd\u5bb6\u8179\u90e8\u624b\u672f\u540e\u6b7b\u4ea1\u7684\u673a\u5236\u4e0e\u539f\u56e0"},"content":{"rendered":"\n

Mechanisms and causes of death after abdominal surgery in low-income and middle-income countries: a secondary analysis of the FALCON trial<\/h1>\n\n\n\n

NIHR Global Health Research Unit on Global Surgery<\/h3>\n\n\n\n

Lancet Global Health 2024 online first September 05, 2024<\/h3>\n\n\n\n

https:\/\/doi.org\/10.1016\/S2214-109X(24)00318-8<\/h3>\n\n\n\n

Summary<\/h2>\n\n\n\n

Background<\/h3>\n\n\n\n

Death after surgery is devasting for patients, families, and communities, but remains common in low-income and middle-income countries (LMICs). We aimed to use high-quality data from an existing global randomised trial to describe the causes and mechanisms of postoperative mortality in LMICs. To do so, we developed a novel framework, learning from both existing classification systems and emerging insights during data analysis.<\/p>\n\n\n\n

Methods<\/h3>\n\n\n\n

This study was a preplanned secondary analysis of the FALCON trial in 54 hospitals across seven LMICs (Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa). FALCON was a pragmatic, 2\u2009\u00d7\u20092 factorial, randomised controlled trial that compared the effectiveness of two types of interventions for skin preparation (10% aqueous povidone\u2013iodine vs<\/em> 2% alcoholic chlorhexidine) and sutures (triclosan-coated vs<\/em> uncoated). Patients who did not have surgery or were lost to follow-up were excluded (n=231). The primary outcomes of the present analysis were the mechanism and cause of death within 30-days of surgery, determined using a modified verbal autopsy strategy from serious adverse event reports. Factors associated with mortality were explored in a mixed-effects Cox proportional hazards model. The FALCON trial is registered with ClinicalTrials.gov<\/a>, NCT03700749<\/a>.<\/p>\n\n\n\n

Findings<\/h3>\n\n\n\n

This preplanned secondary analysis of the FALCON trial included 5558 patients who underwent abdominal surgery, of whom 4248 (76\u00b74%) patients underwent surgery in tertiary, referral centres and 1310 (23\u00b76%) underwent surgery in primary referral (ie, district or rural) hospitals. 3704 (66\u00b77%) of 5558 surgeries were emergent. 306 (5\u00b75%) of 5558 patients died within 30 days of surgery. 226 (74%) of 306 deaths were due to circulatory system failure, which included 173 (57%) deaths from sepsis and 29 (9%) deaths from hypovolaemic shock including bleeding. 47 (15%) deaths were due to respiratory failure. 60 (20%) of 306 patients died without a clear cause of death: 45 (15%) patients died with sepsis of unknown origin and 15 (5%) patients died of an unknown cause. 46 (15%) of 306 patients died within 24 h, 111 (36%) between 24 h and 72 h, 57 (19%) between >72 h and 168 h, and 92 (30%) more than 1 week after surgery. 248 (81%) of 306 patients died in hospital and 58 (19%) patients died out of hospital. The adjusted Cox regression model identified age (hazard ratio 1\u00b701, 95% CI 1\u00b701\u20131\u00b702; p<0\u00b70001), ASA grade III\u2013V (4\u00b793, 3\u00b745\u20137\u00b703; p<0\u00b70001), presence of diabetes (1\u00b747, 1\u00b704\u20132\u00b741; p=0\u00b7033), being an ex-smoker (1\u00b759, 1\u00b710\u20132\u00b730; p=0\u00b7013), emergency surgery (2\u00b708, 1\u00b745\u20132\u00b798; p<0\u00b70001), cancer (1\u00b798, 1\u00b742\u20132\u00b776; p<0\u00b70001), and major surgery (3\u00b794, 2\u00b730\u20136\u00b775; p<0\u00b70001) as risk factors for postoperative mortality.<\/p>\n\n\n\n

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Interpretation<\/h3>\n\n\n\n

Circulatory failure leads to most deaths after abdominal surgery, with sepsis accounting for almost two-thirds. Variability in timing of death highlights opportunities to intervene throughout the perioperative pathway, including after hospital discharge. A high proportion of patients without a clear cause of death reflects the need to improve capacity to rescue and cure by strengthening perioperative systems.<\/p>\n\n\n\n

Funding<\/h3>\n\n\n\n

National Institute for Health and Care Research Global Health Research Unit.<\/p>\n","protected":false},"excerpt":{"rendered":"

Mechanisms and causes of death after abdominal surgery […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27026"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27026"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27026\/revisions"}],"predecessor-version":[{"id":27027,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27026\/revisions\/27027"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27026"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27026"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27026"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}