Mortalidad perioperatoria en Colombia. Perspectivas del indicador cuatro de la comisión de Lancet en cirugía global (COLSOS – Colombian Surgical Outcomes Study)
Thesis
Introduction: Every year, there are approximately 4.2 million deaths in the early postoperative period, most of them in low and middle-income countries, being the third contributor to death worldwide. Therefore, the Lancet Committee on global surgery has called for describing perioperative mortality as a standardized measure to understand the national surgical situation and its international comparison. Therefore, this study aimed to describe perioperative mortality in Colombia. Methodology: A prospective, multicenter, nationwide cohort study was carried out. A total of 3657 patients from 53 institutions in 21 Colombian departments. Patients over 18 years who underwent a surgical procedure on the collection dates were included, excluding patients with incomplete records who did not consent or procedures outside the operating room, radiological or endoscopic. A descriptive analysis was performed along with a mixed linear regression model to perform a multilevel analysis by region. Results: Patients had a median age of 48 years (RIC 18-64), with female sex at 56.2% and a smoking history of 12.7%. Forty-nine percent were from the low-, 37% from the middle-, and 1.4% from the high socioeconomic stratum. Forty-six percent were attended by the EPS contributory regime, 38.3% by the subsidized regime, 6.3% by prepaid, and 5.1% by special regimes. ASA score I or II was found in 80.4% of the patients; most of the procedures were intermediate or low complexity (73%), and 49.6% were elective or programmed. The perioperative mortality rate was 1.87%, and the post-procedure complication rate was 32.4%. Patients undergoing emergency procedures had a perioperative mortality rate of 2.8%, and those over 65 years had a perioperative mortality rate of 4.8%. Protective factors for mortality included body mass index (OR 0.84, 95%CI 0.75-0.93) and elective procedures (OR 0.37, 95%CI 016-0.83), while risk factors included age (OR 1.03, 95%CI 1.01-1.05), chronic obstructive pulmonary disease (OR 3. 31, CI95% 1.26-8.65), complete vaccination schedule for Covid 19 (OR 3.71, CI95% 1.43-9.62), subsidized regime (OR 2.24, CI95% 1.04-4.83), ASA IV score (OR 7. 86, 95%CI 1.94-31.86), perioperative hemodynamic instability (OR 17.8, 95%CI 5.98-52.9) and endovascular approach (OR 9.73, 95%CI 1.19-79.8). Conclusion: Our study is the first of its kind to the best of our knowledge, reporting a higher perioperative mortality rate than previously estimated and an incidence of complications of approximately 1 in 3 procedures in the country. We believe that further investigation of the factors associated with perioperative mortality at the local and national levels is required to reduce the burden of surgical conditions and improve the quality of surgical care services. Finally, we believe that the results of this research may serve as a basis for national and local decision-makers, as well as being one of the first steps in generating a national surgical plan in Colombia.
