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1. Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery – a prospective cohort studyResearch in context

Author

Carlos J. Pérez Rivera, Nicolás Lozano-Suárez, Alejandro Velandia-Sánchez, Maria Paula Vargas-Cuellar, Luisa Fernanda Rojas-Serrano, Camilo A. Polanía-Sandoval, Daniela Lara-Espinosa, Laura García-Zambrano, Maria Paz Bohórquez-Tarazona, Silvia Valentina Agudelo-Mendoza, Paulo A. Cabrera-Rivera, Leonardo Briceno-Ayala, Camilo Andres Polania-Sandoval, María Paula Vargas-Cuéllar, Paulo Andrés Cabrera-Rivera, Danna Cruz-Reyes, Juan Guillermo Barrera Carvajal, Luis Felipe Cabrera-Vargas, Oscar Guevara, Laura Cristina Arce Polania, Laura Natalia Buendía Barrios, María Isabel Cristina Camargo Areyanes, Felipe Casas, Valeria Cormane Alfaro, Juan P. García-Méndez, Bayron Guerra, Sharon V. Idarraga-Ayala, Akram Kadamani Abiyomaa, Christopher Montoya, Manuel Santiago Mosquera Paz, María Alejandra Pineda, Juliana Pinzón-Luna, Isabella Roa Bastidas, Carlos Fernando Roman Ortega, Juan D. Saavedra Henao, Laura Carolina SanJuan-Arias, Vanessa Barreto, Julian Corso, Mariana Maksoud-Garcia, Eliana Pineda Mateus, Alejandra Vega Zabaraín, Fabien Mantilla-Sylvain, Nicolas Perez, Sergio Alzate-Ricaurte, Monica Bejarano, Isabella Caicedo Holguin, Alberto Federico García, Stefania Rodriguez Sanchez, Felipe Bernal Santos, Carlos Luna Jaspe, Maria Camila Luna-Jaspe Roa, Maria Paula OLIVERA Bolívar, MariaFernanda Valdivieso Diaz, Yuli Agudelo, Maria Paula Castillo-Aristizábal, Juan Pablo Hoyos Burgos, Maria Clara Maria Clara Mendoza Arango, Gabriel Arroyave, Felipe Buitrago Preciado, Lina María Cardona González, Juan Camilo Correa-Cote, Karen Lorena Franco Arias, Juan Felipe Llano Sierra, Gustavo López, Cesar Mancero, Sebastian Parra, Beatriz Ramirez Gonzalez, Daniela Sierra, Maria Camila Amaya Muñoz, Ashley Blanco-Ramírez, Paul Anthony Camacho, Jorge Campillo, Andrea Ximena Carvajal Mejia, María Alejandra González Yamil, Juan Carlos Osorno Villegas, Eduardo Rubio, Santiago Sánchez Herrera, Sebastian Sanchez Herrera, Tatiana Agudelo, Valentina Andrade, Laura Arango Pérez, Anibal Ariza-Gutiérrez, Jacobo Berrio, Natalia Cantillo Torres, Maria Valeria Chamorro-Rodríguez, Lucia Conde, Oscar Hernando Feo Lee, María Camila González Nieto, Laura Cecilia Ibañez-Pintor, Catalina Ochoa, Juan Ospina, Juan José Pérez-Ocampo, Esteban Portilla Rojas, Daniela Saaibi Rey, Eduardo Serrano, Sharon Michelle Solorza Velásquez, Angélica María Toro Cubides, Raúl Aguiar, Diego Armando Beltrán Rincón, Juan Sebastian Figueroa, Rafael Figueroa-Casanova, Maria Fernanda Gonzalez Mosos, Marcia Gabriela Gómez, Susana Osorno, Laura Laura Palacio, Jose Venegas, Liliana Marcela Caicedo Ramírez, Diana Catalina Cardona Gomez, Daniel Alejandro Fernandez Bolaños, Adriana Fernández-Diago, Victor David Olave Montaño, César Pastás, Silvia Marcela Amorocho, Jorge Barbosa-Santibañez, Vladimir Baron, Alejandra Cartagena-Alvarado, Maria Castillo, Maria Carolina Castillo-Florez, Omar David Dimian Mayorga, Elena Leonor Delgado-Nieto, Ernesto Fajardo, Omar Leonardo Gomez Polania, Tania Gonzalez, Daniel Felipe Guzman Mesa, Andres Isaza-Restrepo, Jaime A. Leal, Camilo Medina, Jorge Navarro-Alean, Maria Antonia Ocampo, Guillermo Oliveros, Maria Ortiz, Jorge I. Ortiz-Mahecha, Katherine Parra Abaunza, Felipe Antonio Pulido Reyes, Natalia Rivera-Rincón, Carlos Alfonso Rodriguez Pinedo, Lizeth Rodriguez Sanchez, Juan Javier Romero, Juan Carlos Sabogal Olarte, Javier Mauricio Salgado Tovar, Guillermo Andrés Torres, Linda Vallejo, Felipe Vargas-Barato, Ana María Vargas Patiño, Juan Pablo Villate León, Miguel Angel Montañez Aldana, Chiara Norato, Hugo Rojas Borda, Miguel Á Romero Núñez, Alejandro Sánchez, Jose Támara López, Jose Támara P, Wilmer Fernando Botache Capera, Rolando Medina Rojas, Juan Torres, Gina Catalina Trujillo, Gabriela Estefanía Cubillos Saavedra, Francisco García-Laverde, Jussef Camilo Naffah Enciso, Julian Arango Betancur, Adriana Cortés-Coronado, Susana Sepúlveda Tamayo, Valentina Arboleda Cardenas, Luis Guillermo García-Barrero, Jhonatan Enrique Garzón-Galindo, Lina Fernanda Torres Parada, Alejandro Arias Quintero, David Cano, Kevin Fernando Montoya Quintero, Santiago Nieto Muñoz, Paula Saza Mejía, Jesus David Gomez Barrios, María Angélica Jimeno, Ghandi Ignacio Restrepo Hernandez, Adrian Rodríguez-Sequea, Juan Carlos Varón Cotes, Hanner Enrique Acevedo Reyes, Claudia Marcela Barandica Bolaño, Maria Camila Sierra-Cote, Laura Daniela Angarita Vargas, Alix Yurany Báez Ramírez, Jose Armando Rodriguez Suarez, David Leonardo Sánchez, Silvia Natalia Sandoval Rangel, Edwin Ulloa Hurtado, Olga Esther Hernández Almanza, Rosalba Inmaculada Martínez Zubiria, Angel Alexis Muegues Salas, Diego Alexander Becerra Cardona, Fabio Hernán Cárdenas Santamaría, Juan Daniel Echeverri Castaño, Juan Sebastián Echeverri Uribe, María Helena Gaitán Buitrago, Luis Felipe Galvis Valencia, Andrea Henao Sabogal, David Felipe López Atehortúa, Juan Manuel Molina Uribe, Edwin Enrique Peñate Suárez, Heiller Torres Valencia, Marcela Velásquez Salazar, Catalina Correa, Hans García, Juan Hernández Leal, Paula Tatiana Muñoz Vargas, Dínimo José Bolívar Sáenz, Camilo Andrés Caicedo Medina, Camilo Andres Garcia Riaño, Stephanye Carrillo Gonzalez, Jaime Lorduy Gómez, Carlos Torres Madrid, Walter Torres Villa, Juan Sebastian Luengas Orozco, Camilo Avendaño Capriles, Carolina Diaz Blanco, Maria Lucía Brieva Hoyos, Paola Andrea Cantillo Moreno, Sofía Carolina Granados Mendoza, José Dario Vizcaino Lara, Karla Lizeth Babativa Peñuela, Paula Andrea Jiménez Bahamón, Jhonier Estiven Maldonado Rico, Duvan Ernesto Martínez Cortes, José Alfredo Orjuela Aragón, Lizeth Daniela Castro Roa, Julieth Sarmiento Gallego, Marta Maria Herazo Meza, Anlly Caterin Hernández Castillo, Rosa Gabriela Rojas Moncada, Lucia Fernanda Casanova Bermeo, Oscar Fernando Cortés Otero, Nicolás Diaz Pinilla, Harrison Rene Herrera Delgado, Simon Alberto Macías Segura, David Ramiro Muñoz Castrillón, Luis Ramiro Nuñez Romero, Cesar Andrés Polania Andrade, Hector Alejandro Valdez Toro, Ana María Cardozo Parrado, Jose Gonzalo Moros, Paula Andrea Nieto, Jorge Mario Patarroyo, Jose Luis Perilla Martínez, María del Pilar Torres Gutierrez, Erika Johana Benito Flórez, Mariana Vergel Gómez, Diana Ximena Robayo Rodriguez, Diego Fernando Salcedo Miranda, Maria Alejandra Triviño Cortés, William Baquero Sastre, Juan Sebastian Bonett, Eliana Cortes, Pedro Fernando Duque, Carlos Enrique Gutierrez, Piedad Echeverry, Andrés Felipe Motta Amar, Lorena Torres, Jeremias Carvajal Bautista, David Mauricio Figueroa Bohórquez, Manuel Latorre Quintana, Diego Fernando Olivera Briñez, Marcel Leonardo Quintero Contreras, Raúl Vera Gamboa, Mariana Arias Zapata, Cristhian Daniel Benavides Caipe, Luisa Fernanda Betancur Acevedo, Valentina Botero Zuluaga, Vanessa Figueroa-Espinoza, Arbey Leandro Londoño-Patiño, Santiago Moncayo-Gonzalez, Laura Sofia Puerta Suárez, Paula Camila Vargas-Arboleda, Lisbet Sofia Gonzalez Cera, Katerine Henao Toro, Leobardo de Jesus Ortiz Pino, Sergio Andrés Vasquez Vargas, Lency Naranjo Zuluaga, Jaime Chamorro Garzón, Adriana Paola Franco Rodriguez, Nataly Johana Acosta Alape, Andrés Felipe Arbelaez Mariño, Juan José Mora Herrera, Javier Felipe Ayala Muñoz, Yeiny Carina Camacho Pinzon, José Francisco Cárdenas Chacón, Liliana Andrea Peña Arenas, Gustavo Adolfo Rodriguez Camargo, Carlos Alberto Sánchez Arango, Daniel Mauricio Bolaños Ñañez, Diana Sofía Garcés-Palacios, María Alejandra Ñañez Pantoja, Omar Alejandro Ortega-Valencia, María Paula Gamboa Bernal, Juan David Lotero Gómez, Juan Sebastián Martínez-Gutiérrez, Daniel Morales-Gómez, Lina Pardo-Jiménez, Leon Miguel Fonseca Galindo, Angélica Maria Garcia Ramirez, Juan David Saurith Ramirez, Ivan Ricardo Barrero Montoya, Santiago Cadena Espitia, Salomé Pallares Rojas, Laura Camila Zapata Berrio, Diana Andrea Benavides Rodríguez, Juan Carlos Gonzalez, Sharon Valentina Idarraga, Óscar Eduardo Márquez Rodríguez, Ivi Yohana Marrugo Prieto, Laura Vanessa Soledad Machado, Rubén Luna, Nicolás Navarro Pulido, Federico Javier Nuñez Ricardo, Andrea Elena García López, Fernando Girón Luque, Nasly Patiño Jaramillo, Néstor Fabian Pedraza Alonso, Javier Yecid Acuña Acuña Rivera JY, Oscar Alexander Guevara Cruz, Juan Sebastián Martínez Buitrago, Nathalia Montoya Oviedo, Marcia Roxana Santafe Guerrero, Juanita Carolina Chaves Cortés, Francisco Mauricio Rincón Tello, Diana Fernanda Bejarano Ramirez, Nicolas Andres Cortes Mejia, Camilo Ernesto Garzon Mesa, Alejandra Moncada Pabon, Diego Rymel Triviño Alvarez, Alonso Vera Torres, Maria Alejandra Cote Martinez, Juan Manuel Machado Rodriguez, Gonzalo Nuñez Martinez, Laura Naranjo Osuna, Andres Felipe Roldan Garay, Daniel Amado, Jaime Camacho-Mackenzie, Maria Ceballos Mora, Sara Cifuentes-Navarrete, Andrea Donoso-Samper, Manuel A. Ferro, Juan C. Gómez-Cáceres, Sebastián Gómez-Galán, Ana G. Leiva, Juan Lisarazo, Maria G. López-Castaño, Sofía Martínez-Gil, M.J. Montoya, Santiago Niño-Basto, Sergio Andrés Ortigoza-Espitia, Gustavo Páez, Jesús William Ramos-Anaya, María J. Rozo, Juan P. Umana, Andres Motta Amar, Andrés Felipe Barrera Vargas, Javier Dario Maldonado Escalante, German Ricardo Molina Marroquin, and Silvia Alejandra Prada Lievano

Subjects
Global health, Public health, Surgery, Health policy, Hospital mortality, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.

Published
2024
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2. Perioperative mortality in Colombia: perspectives of the fourth indicator in The Lancet Commission on Global Surgery – Colombian Surgical Outcomes Study (ColSOS) – a protocol for a multicentre prospective cohort study

Author

Carlos J Pérez-Rivera, Nicolás Lozano-Suárez, Alejandro Velandia-Sánchez, Camilo A Polanía-Sandoval, Juan P García-Méndez, Sharon V Idarraga-Ayala, Julián M Corso-Ramírez, Danny Conde-Monroy, Danna L Cruz-Reyes, Carlos F Durán-Torres, Juan G Barrera-Carvajal, Luisa Fernanda Rojas-Serrano, Laura Alejandra Garcia-Zambrano, Silvia Valentina Agudelo-Mendoza, Leonardo Briceno-Ayala, Paulo A Cabrera-Rivera, Gustavo-Adolfo Quintero-Hernandez, Lilian Torregrosa-Almonacid, Luis F Cabrera-Vargas, Felipe Casas-Jaramillo, Valeria Cormane-Alfaro, Laura N Buendía-Barrios, Laura C Arce-Polanía, Maria A Pineda-Castañeda, Juan D Saavedra-Henao, Daniela Lara-Espinosa, Santiago Garcés-Marulanda, Juliana Pinzón-Luna, Bayron R Guerra-Benedetti, María P Vargas-Cuéllar, Carlos E Rodriguez-Barbosa, Daniel A Buitrago-Medina, Sebastian Gallo-Bernal, Manuel S Mosquera-Paz, Akram Kadamani-Abiyomaa, Isabella Roa, Isabella Velandia-Sánchez, Julian A Garavito-González, Carlos F Román-Ortega, Maria I Camargo-Areyanes, Mariana Maksoud-García, María P Bohórquez-Tarazona, Vanessa Barreto, and Fabien Mantilla-Sylvain

Subjects
Medicine
Abstract

Introduction Death following surgical procedures is a global health problem, accounting for 4.2 million deaths annually within the first 30 postoperative days. The fourth indicator of The Lancet Commission on Global Surgery is essential as it seeks to standardise postoperative mortality. Consequently, it helps identify the strengths and weaknesses of each country’s healthcare system. Accurate information on this indicator is not available in Colombia, limiting the possibility of interventions applied to our population. We aim to describe the in-hospital perioperative mortality of the surgical procedures performed in Colombia. The data obtained will help formulate public policies, improving the quality of the surgical departments.Methods and analysis An observational, analytical, multicentre prospective cohort study will be conducted throughout Colombia. Patients over 18 years of age who have undergone a surgical procedure, excluding radiological/endoscopic procedures, will be included. A sample size of 1353 patients has been projected to achieve significance in our primary objective; however, convenience sampling will be used, as we aim to include all possible patients. Data collection will be carried out prospectively for 1 week. Follow-up will continue until hospital discharge, death or a maximum of 30 inpatient days. The primary outcome is perioperative mortality. A descriptive analysis of the data will be performed, along with a case mix analysis of mortality by procedure-related, patient-related and hospital-related conditionsEthics and dissemination The Fundación Cardioinfantil-Instituto de Cardiología Ethics Committee approved this study (No. 41–2021). The results are planned to be disseminated in three scenarios: the submission of an article for publication in a high-impact scientific journal and presentations at the Colombian Surgical Forum and the Congress of the American College of Surgeons.Trial registration number NCT05147623.

Published
2022
Full Text
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3. Perioperative mortality in Colombia: perspectives of the fourth indicator inThe LancetCommission on Global Surgery – Colombian Surgical Outcomes Study (ColSOS) – a protocol for a multicentre prospective cohort study

Author

Carlos J Pérez-Rivera, Nicolás Lozano-Suárez, Alejandro Velandia-Sánchez, Camilo A Polanía-Sandoval, Juan P García-Méndez, Sharon V Idarraga-Ayala, Julián M Corso-Ramírez, Danny Conde-Monroy, Danna L Cruz-Reyes, Carlos F Durán-Torres, Juan G Barrera-Carvajal, Luisa Fernanda Rojas-Serrano, Laura Alejandra Garcia-Zambrano, Silvia Valentina Agudelo-Mendoza, Leonardo Briceno-Ayala, and Paulo A Cabrera-Rivera

Subjects
General Medicine
Abstract

IntroductionDeath following surgical procedures is a global health problem, accounting for 4.2 million deaths annually within the first 30 postoperative days. The fourth indicator ofThe LancetCommission on Global Surgery is essential as it seeks to standardise postoperative mortality. Consequently, it helps identify the strengths and weaknesses of each country’s healthcare system. Accurate information on this indicator is not available in Colombia, limiting the possibility of interventions applied to our population. We aim to describe the in-hospital perioperative mortality of the surgical procedures performed in Colombia. The data obtained will help formulate public policies, improving the quality of the surgical departments.Methods and analysisAn observational, analytical, multicentre prospective cohort study will be conducted throughout Colombia. Patients over 18 years of age who have undergone a surgical procedure, excluding radiological/endoscopic procedures, will be included. A sample size of 1353 patients has been projected to achieve significance in our primary objective; however, convenience sampling will be used, as we aim to include all possible patients. Data collection will be carried out prospectively for 1 week. Follow-up will continue until hospital discharge, death or a maximum of 30 inpatient days. The primary outcome is perioperative mortality. A descriptive analysis of the data will be performed, along with a case mix analysis of mortality by procedure-related, patient-related and hospital-related conditionsEthics and disseminationThe Fundación Cardioinfantil-Instituto de Cardiología Ethics Committee approved this study (No. 41–2021). The results are planned to be disseminated in three scenarios: the submission of an article for publication in a high-impact scientific journal and presentations at the Colombian Surgical Forum and the Congress of the American College of Surgeons.Trial registration numberNCT05147623.

Published
2022

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