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American Journal of Surgery

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Disparate outcomes of global emergency surgery - A matched comparison of patients in developed and under—developed healthcare settings - 13/06/18

Doi : 10.1016/j.amjsurg.2018.05.008 
Adil A. Shah a, b, e, Cheryl K. Zogg c, d, Abdul Rehman e, Asad Latif g, h, Hasnain Zafar e, Amarah Shakoor f, Nabil Wasif b, Alyssa B. Chapital b, Robert Riviello d, Awais Ashfaq i, Mallory Williams a, Edward E. Cornwell a, Adil H. Haider d, ⁎
a Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA 
b Division of General Surgery, Mayo Clinic, Phoenix, AZ, USA 
c Yale University, School of Medicine, New-Haven, CT, USA 
d Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA 
e Department of Surgery, Aga Khan University, Karachi, Pakistan 
f Charleston Area Medical Center, West Virginia University, Charleston, WV, USA 
g Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA 
h Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 
i Department of Cardiothoracic Surgery, Oregon Health Sciences University, Portland, OR, USA 

∗Corresponding author. Kessler Director Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, 1620 Tremont Street, One Brigham Circle, 4th Floor, Suite 4-020, Boston, MA, 02120, USA.Kessler Director Center for Surgery and Public HealthDepartment of SurgeryBrigham and Women's Hospital1620 Tremont StreetOne Brigham Circle4th FloorSuite 4-020BostonMA02120USA

Abstract

Introduction

Access to surgical care is an essential element of health-systems strengthening. This study aims to compare two diverse healthcare settings in South Asia and the United States (US).

Methods

Patients at the Aga Khan University Hospital (AKUH), Pakistan were matched to patients captured in the US Nationwide Inpatient Sample (US-NIS) from 2009 to 2011. Risk-adjusted differences in mortality, major morbidity, and LOS were compared using logistic and generalized-linear (family gamma, link log) models after coarsened-exact matching.

Results

A total of 2,244,486 patients (n = 4867 AKUH; n = 2,239,619 US-NIS) were included. Of those in the US-NIS, 990,963 (42.5%) were treated at urban-teaching hospitals, 332,568 (14.3%) in rural locations. Risk-adjusted odds of reported mortality were higher for Pakistani patients (OR[95%CI]: 3.80[2.68–5.37]), while odds of reported complications were lower (OR[95%CI]: 0.56[0.48–0.65]). No differences were observed in LOS. The difference in outcomes was less pronounced when comparing Pakistani patients to American rural patients.

Conclusion

These results demonstrate significant reported morbidity, mortality differences between healthcare systems. Comparative assessments such as this will inform global health policy development and support.

El texto completo de este artículo está disponible en PDF.

Highlights

•
Global surgery has long been recognized as the “neglected stepchild” of public health.
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Southeast Asia, has the lowest number of optimally-equipped operating theatres.
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This is a comparative analysis of a matched cohort of Pakistani and US emergency surgery patients.
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Despite stark differences in outcomes, these were less pronounced when comparing Pakistani patients to rural US.
•
Comparative assessments such as this will inform global health policy development and support.

El texto completo de este artículo está disponible en PDF.

Keywords : Emergency general surgery, Pakistan, Low-middle income, Global surgery, Coarsened-exact matching


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Vol 215 - N° 6

P. 1029-1036 - juin 2018 Regresar al número
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