Around the world 4.2 million people die every year within 30 days after surgery—with half of these deaths occurring in low- and middle-income countries (LMICs), a new study reveals.

There is also a significant unmet need for surgery in LMICs and researchers believe that if operations were provided for all patients who need them the number of global post-operative deaths would increase to 6.1 million.

Researchers at the University of Birmingham published their analysis on the numbers of people dying within 30 days of surgery in a research letter to The Lancet. They estimate that more people die each year within 30 days after surgery than from HIV, tuberculosis, and malaria combined (2.97 million).

The Lancet Commission on Global Surgery identified that 313 million surgical procedures are performed each year, but little is known about the quality of surgery globally, as robust postoperative death rates are available for only 29 countries.

Researchers at the University’s NIHR Global Health Research Unit on Global Surgery analysed available information to estimate how many people around the world die after operations—based on surgical volume, case-mix and post-operative death rates adjusted for country income.

Dr. Dmitri Nepogodiev, Research Fellow at the University of Birmingham, commented: “Surgery has been the ‘neglected stepchild’ of global health and has received a fraction of the investment put in to treating infectious diseases such as malaria.

“Although not all postoperative deaths are avoidable, many can be prevented by increasing investment in research, staff training, equipment, and better hospital facilities. 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.”

Professor Dion Morton, Barling Chair of Surgery at the University of Birmingham and Director of Clinical Research at the Royal College of Surgeons of England, commented: “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. 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.”

The researchers project that expanding surgical services to address unmet need would add another 1.9 million post-operative deaths in LMICs each year. Based on 4.2 million deaths, 7.7% of all deaths globally occur within 30 days of surgery. This figure is greater than that attributed to any other cause of death globally except ischaemic heart disease and stroke .

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