Global burden of postoperative death: Postoperative surgical complications; the practising surgeons current nemesis

By Dr Parvez David Haque, Associate professor –Surgery, Christian Medical College &Hospital, Ludhiana, Punjab

Every year 4.2million people die worldwide within 30 days of surgery. An analysis of data from 29 countries by the University of Birmingham, published as recent as February 2019 in Lancet journal, revealed a staggering 1.23million more die after going under the knife than from HIV, TB and malaria combined. Overall, 7.7 per cent of all fatalities worldwide occur within 30 days of the deceased going under the knife - with only heart disease and stroke being bigger killers. 'Postoperative complications' - such as bleeding and infections - are thought to be behind most of these deaths. The authors claim surgery is the 'neglected stepchild of global health' after too much money has been pumped into treating infectious diseases.The research was carried out by the University of Birmingham and led by Dr Dmitri Nepogodiev, from the department of public health and surgery.Dr Nepogodiev said. 'Although not all postoperative deaths are avoidable, many can be prevented by increasing investment in research, staff training, equipment, and better hospital facilities.'Tuberculosis is the tenth most common cause of global deaths and is responsible for 2.2 percent of fatalities every year. HIV and malaria are not in the top ten.Coronary heart disease - when the organ's blood supply is blocked due to plaque in the arteries - is the biggest killer and makes up 17.3 per cent of alldeaths every year.This is followed by stroke - at 10.1 percent of deaths - and then surgery. Of the 4.2million who pass away following surgery, half occur in low or middle-income countries, India happens to be a LMIC.And people living in these nations are often forced to go without much-needed surgery.The researchers estimate 4.8billion people around the world lack access to safe and affordable operations. In these poor regions, 143million procedures are not being carried out every year despite patients being in critical need.If these operations were performed, the annual death toll after surgery would increase further to 6.1million, the authors claim.'To avoid millions more people dying after surgery, planned expansion of access to surgery must be complemented by investment in to improving the quality of surgery around the world,'Dr Nepogodiev said.Study author Professor Dion Morton - chair of surgery at the University of Birmingham - adds that as access to operations improves, so must the safety of these procedures. 'Surgery saves lives and can transform patients' quality of life, but this study shows that a large number of patients die in the immediate postoperative period,' he said.'As efforts continue to increase access to surgery around the world, there is also an urgent need for research to improve the quality and safety of surgery.
Dr Dhruva Nath Ghosh, a consultant pediatric surgeon at Christian Medical College and Hospital Ludhiana,has been part of this Global research initiative, which has far reaching implications towards the Indian health sector affecting patients, operating surgeons,hospitals and surgical care in general.
Dr Parvez David Haque, Associate Professor of Surgery informed that the Dr Kavita Mandrelle, Dr Nandini K Bedi, Dr Vishal Michael, Dr Dhruv Ghosh and himself from the Departments of General Surgery, Pediatric Surgery, Obstetrics and Gynaecology at Christian Medical College and Hospital Ludhiana [PUNJAB] is a part of the international research group called Global Surg. They will be participating in the “FALCON TRIAL- Global surgery research collaborative in LMIC[low middle income countries] an initiative to reduce postoperative complications like wound infections which lead to mortality particularly in emergency abdominal surgery. Dr Haque will be one of the leaders of this research in India.