New global surgical guidelines to cut post-surgery deaths in poor countries

Sierra Leone Telegraph: 25 June 2019:

The English National Health Service (NHS) reduced post-operative deaths by 37.2% following the introduction of globally recognised surgical guidelines – paving the way for life-saving action in low- and middle-income countries (LMICs), a new study reveals.

Researchers at the University of Birmingham, UK, have confirmed that the NHS achieved the reduction between 1998 and 2014, coinciding with the introduction of the World Health Organisation (WHO) Surgical Safety Checklist in 2008.

Investigation of data showed a consistent downward trend over the 16-year period, with the greatest reductions achieved in oesophagogastric (68.8%) and breast (69.3%) surgery.

The researchers published their analysis on the reduction of postoperative mortality rates (POMR) in a research letter to British Journal of Surgery. Their findings echo the results of similar research into NHS Scotland for the period 2000 to 2014, which found that the WHO Checklist was a key driver in POMR by 39%.

Mr Aneel Bhangu, Senior Lecturer at the University of Birmingham, commented: “Around the world 4.2 million people die every year within 30 days after surgery – with half of these deaths occurring in LMICs. Identification of strategies to reduce postoperative mortality is now a global research priority.

“It is encouraging that despite having among the lowest baseline rates globally, both Scotland and England have achieved a greater than one-third reduction in overall POMR. Replicating these gains internationally could avoid thousands of postoperative deaths, with the greatest potential gains in LMICs.”

He added that the checklist was essential part of improving perioperative safety, although variable reductions in deaths across specialties suggested that procedure specific initiatives have made a major contribution to reducing overall POMR.

Researchers at the University’s NIHR Global Health Research Unit on Global Surgery replicated the analysis of NHS Scotland performance using publicly available inpatient POMR data. They discovered a 37.2% relative reduction (1.21 to 0.76%) in overall inpatient POMR.

The study followed the Unit’s research, published earlier this year in The Lancet, which discovered the figure of 4.2 million deaths every year within 30 days after surgery.

There is also a significant unmet need for surgery in LMICs and researchers believe that if operations were provided for all patients who need them the number of global post-operative deaths would increase to 6.1 million.

Around 4.8 billion people worldwide lack timely access to safe and affordable surgery and it is estimated that there is an annual unmet need for 143 million procedures in LMICs.

The University of Birmingham is ranked amongst the world’s top 100 institutions, its work brings people from across the world to Birmingham, including researchers and teachers and more than 6,500 international students from over 150 countries.

The National Institute for Health Research (NIHR) is the UK’s largest funder of health and care research. The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.

NIHR funded the NIHR Global Health Research Unit on Global Surgery to build capacity and sustainable surgical research infrastructures in partner LMICs. The Unit works closely together with its UK and LMIC partners to deliver research studies and disseminate the findings.

For the current 2019 fiscal year, the World Bank defines low-income economies as those with a GNI per capita, calculated using the World Bank Atlas method, of $995 or less in 2017; lower middle-income economies are those with a GNI per capita between $996 and $3,895; upper middle-income economies are those with a GNI per capita between $3,896 and $12,055; high-income economies are those with a GNI per capita of $12,056 or more.


  1. Great news to be celebrated by all humanity, especially our people in Africa. The British NHS reducing Post Operative Deaths by 37 percent is a tremendous achievement that deserves the loudest applauses and accolades. Post operative deaths that is also referred to in medical terms as ‘Perioperative Mortality’, has been a disaster song being played and heard in many African countries, tirelessly for decades and scores of years gone by.

    In Africa where individual and household incomes are extremely low, being able to afford high quality, surgical operations is a rare miracle that many who are sick, can only hope for, that will never materialize in their lives. Again lack of highly efficient medical facilities is another pressing and daunting challenge africans have to deal with whenever they fall sick and need urgent medical care.

    In most rural and remote parts of some countries, there are no hospitals at all – no a single one! Many dying and sick patients have to be transported,sometimes for many miles in order to see the nearest doctor. And when they get there, they are asked to wait again for countless hours before being allowed to see a anyone. Sadly, by the time doctors realize that the patient desperately needs an urgent operation, they are already dead or they die while undergoing surgery; and for some, a day or week after they get home.

    This is the African story – and it cuts across the board – one size fits us all. In Africa, a friend once said to me – it is not surprising for hospitals to be mistaken for mortuaries, because in both places, there are dead men laying around everywhere. Some patients still alive awaiting for operations are already dead, but not knowing it at all.

    Post operative deaths can be drastically reduced in the African continent if governments get deeply involved, by implementing laws that favor sick patients in desperate need of operations, while at the same time providing lucrative incentives for doctors, nurses and other essential medical staff.

    There is an urgent need also for specialists and highly trained doctors, that possess the skills to perform successful operations, with great ease. It is said that about 5 billion people lack access to safe and dependable surgery across the globe. Governments need to do more to help the ailing and the sick; empty rhetoric will not suffice.

    Again, not having access to the latest surgical tools, that could make operations easier, and flawless, thereby increasing the patient’s odds for survival, is another factor is contributing to Post Operative Deaths. I have been told, that trauma is the leading cause of death of most patients, that have undergone substandard, poor-quality operation in African hospitals.

    Some of our brother and sisters should be given extra training and made to serve under experts and other qualified medical personnel, in order to gain more experience in their professions. I mean, come on now – if Africans need butchers, they know marketplaces where to find them; and trust me they will never look in hospitals where there are many butchers carrying knives, that call themselves medical doctors, who do not know when to stitch, cut or replace. Rising Sun Will Rise Again.

  2. The best appoach to saving people´s lives. This is one of the best news read today. I am 100% sure new improvements will save the lives of many people.

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