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Perioperative mortality rate (POMR): a global indicator of access to safe surgery and anaesthesia
David A Watters1, Michael J Hollands, Russell L Gruen
1Deakin University and Barwon Health, Royal Australasian College of Surgeons, 1 Spring Street, Melbourne, VIC, 3000, Australia, watters.david@gmail.com.
Insights
The perioperative mortality rate (POMR) is proposed as a global indicator for surgical care access and safety. This metric, measuring deaths on the day of surgery or before discharge/30 days, is feasible and credible for national reporting.
Area of Science:
- Global Health
- Surgical Outcomes
- Healthcare Indicators
Background:
- Substantial unmet global burden of surgical disease affects 2 billion people.
- Lack of access to emergency and essential surgical care leads to preventable deaths and disabilities.
- Inadequate treatment of surgical conditions causes deformities, particularly in children.
Framework:
- Proposes the perioperative mortality rate (POMR) as a credible indicator for surgical care.
- Recommends measuring POMR as deaths on the day of surgery or before discharge/30 days.
- Advocates for POMR reporting as a global health indicator.
Implementation:
- POMR calculation: deaths (numerator) over procedures (denominator).
- Offers flexibility for low- to middle-income countries (before discharge or 30 days).
- Facilitates clinical interpretation via risk stratification (age, urgency, procedure, ASA grade).
Implications:
- POMR reporting is feasible, credible, and achieves international consensus.
- Supports improved access to and safety of essential surgical services worldwide.
- Enables risk-adjusted interpretation of surgical outcomes at hospital and service levels.
Introduction:
The unmet global burden of surgical disease is substantial. Currently, two billion people do not have access to emergency and essential surgical care. This results in unnecessary deaths from injury, infection, complications of pregnancy, and abdominal emergencies. Inadequately treated surgical disease results in disability, and many children suffer deformity without corrective surgery.
Methods:
A consensus meeting was held between representatives of Surgical and Anaesthetic Colleges and Societies to obtain agreement about which indicators were the most appropriate and credible. The literature and state of national reporting of perioperative mortality rates was reviewed by the authors.
Results:
There is a need for a credible national and/or regional indicator that is relevant to emergency and essential surgical care. We recommend introducing the perioperative mortality rate (POMR) as an indicator of access to and safety of surgery and anaesthesia. POMR should be measured at two time periods: death on the day of surgery and death before discharge from hospital or within 30 days of the procedure, whichever is sooner. The rate should be expressed as the number of deaths (numerator) over the number of procedures (denominator). The option of before-discharge or 30 days is practical for those low- to middle-income countries where postdischarge follow-up is likely to be incomplete, but it allows those that currently can report 30-day mortality rates to continue to do so. Clinical interpretation of POMR at a hospital or health service level will be facilitated by risk stratification using age, urgency (elective and emergency), procedure/procedure group, and the American Society of Anesthesiologists grade.
Conclusions:
POMR should be reported as a health indicator by all countries and regions of the world. POMR reporting is feasible, credible, achieves a consensus of acceptance for reporting at national level. Hospital and Service level POMR requires interpretation using simple measures of risk adjustment such as urgency, age, the condition being treated or the procedure being performed and ASA status.