Patient outcomes after surgery in 17 Latin American countries (LASOS): a 7 day prospective cohort study
Adrián Alvarez, Sean M. Bagshaw, Bruce Biccard, Luis Alejandro Boccalatte, Delia Borunda, Jose Andrés Calvache, Maria José Carvalho Carmona, Nicole M. Castillo-Huerta, Shane Charles, A. Medina, Martha Delgado, Alexander J. Fowler, Melba Frias, Ludhmila Abrahão Hajjar, Russ Hewson, M.L. Illescas, Kelly Kon-Liao, Sylvia Batista Lemaire, Eddy Lincango-Naranjo, Mónica Susana Martínez, Santiago Mc Loughlin, Cindy Montoya, Leticia Nakada, Lizbeth G Ortiz, Greg Padmore, Akshaykumar Patel, Rupert M. Pearse, Vinícius Caldeira Quintão, Juan Riva, Ismael Domínguez-Rosado, Sebastian Shu, Rodrigo Soza-Argaña, Luciana Paula Cadore Stefani, Mayra Vaca, Nicolás Villablanca, Duminda N. Wijeysundera, Ozama B Zachi, Ana G Del Arroyo, Adriana Pérez, A. Roca, Florencia P Prieto, Laura Villarino, Carolina Bocci, Maria A Bilos, Virgina E Aredes, Leonardo Masri, Víctor Serafini, Alejandra V Currao, Maria V Feola, Ana I Leone, Alex R López, Pablo E Martin, Ingrid Warnes, Victoria D Turesso, Tomas E Hudson, Camila Bof, Andrea Del Carretto, Analía Ciccola, Federico Nicola, Horacio A Mazzini, Amira L Dayoub, Clara Baldi, Mariana Ceretti, Macarena Risso, Lucas Bacino, Jorge E Filisetti, Milton Szakura, Ailen Furlan, Lautaro Alvarez, Javier A. Márquez, Alan P Cragnulini, Jerónimo Matassa, Bianca Ballarino, P. Albarracin, Agustín E Collia, Nicolás Celso, Valeria P Boschini, Carlos D Romero, José Ignacio Sánchez-Méndez, Alberto J Veloso, Guadalupe Saco, Julian Capurro, Hernan E Szmulewicz, Martin Montanaro, Fabian Diaz, Rodolfo Sanz, Diego Toscana, Esteban J Lafuente, Valeria P Boschini, In Hong Hwang, Germán Masnata, Maria F Pedemonte, Begoña Marí-Alfonso, Lautaro Felix, F. Tano, Silvia E Vargas, Raul L Varela, Agustina Olmedo, M.D. Abós Olivares, Mauro Bottegal
Abstract
BACKGROUND: Access to safe surgical treatment across Latin America is limited by underfunded and fragmented health systems. Epidemiological data are required to describe surgical activity and patient outcomes. METHODS: We did this 7 day prospective cohort study in 17 Latin American countries, collecting data describing inpatient surgery in adults (aged ≥18 years). The primary outcome was in-hospital postoperative complications within 30 days after surgery. Secondary outcomes were in-hospital mortality, duration of hospital stay, and admission to critical care within 30 days after surgery. This study is registered with ClinicalTrials.gov, NCT05169164. FINDINGS: Between June 1, 2022, and April 30, 2023, we included 22 126 patients (mean age 49·7 years [SD 18·2]; 9260 [41·9%] male and 12 866 [58·1%] female; 10 180 [46·0%] White) from 284 hospitals. Of the 22 126 patients, 657 (3·0%) patients for the outcome of complications and 380 (1·7%) patients for mortality had missing data. Most patients were low risk (American Society of Anesthesiologists [ASA] grade I or II: 17 311 [78·7%] of 21 979 patients), undergoing non-major surgery (14 944 [68·0%] of 21 986 patients), and on an elective basis (14 837 [67·5%] of 21 988 patients). Despite this low-risk profile, 3163 (14·6%) of 21 632 patients developed postoperative complications resulting in 477 (2·2%) deaths. The most frequent complication category was infection, affecting 1795 (8·2%) patients. The high mortality from complications (failure to rescue) of 15·1% (477 deaths in 3163 patients with complications) suggests significant problems with postoperative care. 2978 (13·6%) patients were admitted to a critical unit immediately after surgery, but 180 (37·7%) of 477 patients who died never received critical care. Patients with complications had a median hospital stay of 8 days (IQR 3-18), compared with 2 days (1-3) for patients without complications. Postoperative mortality and complications were strongly associated with increasing ASA grade, urgency of surgery, and grade of surgery (intermediate and major). INTERPRETATION: Patients receiving inpatient surgery in Latin America experienced high mortality rates, likely relating to standards of ward care after surgery. Given the rising demand for surgical treatments, resource-efficient measures are urgently needed to improve patient outcomes after surgery across Latin America. FUNDING: None. TRANSLATIONS: For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.