The Comparability and Utility of Perioperative Mortality Rates in Global Health

Abstract

To examine the comparability and utility of perioperative mortality rate (POMR) as a key global surgery metric and the added potential for mortality review to drive continuous quality improvement. There is a wide variation in the perioperative mortality rate (POMR) reported between countries, even for the three Bellwether procedures (emergency laparotomy, emergency caesarean section, management of an open fracture) and other common procedures. Clinical registries such as the National Emergency Laparotomy Audit target high-mortality procedures. Nationally, administrative databases may be used to adjust for risk factors such as age, urgency, socio-economic status and ethnicity, as well as regional variation. To improve care, clinical governance requires practitioner, peer and multidisciplinary review of all avoidable deaths attributable to surgical disease. Appropriately messaged, POMR is a useful metric for health stakeholders and informative for National Surgical, Obstetric and Anaesthesia Plan (NSOAP). The combination of a national database background reporting POMR and clinical governance through local peer and case review of individual mortalities is essential for improving perioperative care.