What is the Perioperative Mortality Rate and What is the Association Between Type of Acute Surgical Intervention and Perioperative Mortality Among Adult Trauma Patients in an Urban Indian Setting?

Introduction

Trauma can be defined as damage inflicted on the body as the result of an external force, and the body's associated response. It is one of the leading causes of death world-wide, causing almost five million deaths yearly, making up for close to nine per cent of global deaths. Of these, road traffic injury alone causes 1.3 million, making it the ninth leading cause of death, with a predicted rise to seventh leading cause by 2030. Overall, however, the world has experienced an increase in life-expectancy over the past 30 years, as well as a decrease in infant and maternal mortality. With evidence suggesting that surgical care results in at least one million deaths per year, twice the number of maternal deaths, it has been established that new health metrics are needed for assessing health system performance.

The WHO Safe Surgery Saves Lives initiative proposes two metrics: day-of-surgery mortality, and 30-day postoperative in-hospital mortality. The subsequently introduced perioperative mortality rate (POMR) comprises these two. To date, no standard timespan for day-of-surgery measurement prevails - the same day as surgery has been suggested for convenience, while some institutions measure at 24, and others at 48 hours after surgery. The outcomes required to calculate POMR (death and number of surgeries) are easily defined. Additionally, there is an option to end follow-up at discharge, which makes the metric suitable for use in low-resource settings, where 30-day follow-up is rare. These are qualities that make POMR the choice of index for tracking the quality and safety of surgery in the world.

Analyses of databanks of surgical patients establish some factors that are more intimately linked to perioperative mortality (POM) than others. In trauma, especially, thorough risk adjustment is highly stressed to enable comparisons at hospital and patient level. However, the data yielding adjustment models largely stems from high-income countries, which is relevant considering that not all risk factors associated with POM in a high-resource setting are applicable in a low-resource setting. This owes to the scarcity of data on surgical programs in low-resource settings, not least in India. As the country faces increasing motorisation, and with it an increase in trauma patients for which factors associated with POM is poorly understood, bridging this knowledge gap is important.

Therefore, this study will be estimating the POMR and assessing the association between type of acute surgical intervention and POM among adult trauma patients in an urban Indian setting.