Excess Surgical Mortality: Strategies for Improving Quality of Care

Authors: Tom Weiser, Atul Gawande

This chapter investigates the level of mortality – about 7 million people suffer complications – after surgery each year, especially in LMICs where safety, appropriateness, and quality of surgical services need to improve. Multiple factors contribute to the risks that surgical patients face in resource-constrained environments due to catastrophic costs, geographic and transportation barriers, and delay in care-seeking behaviors. Safety issues occur during administration of anesthesia and postoperative care or due to lack of anesthesia and failure to follow World Health Organization (WHO) standards. Effective strategies have been identified for improving surgical outcomes in LMICs: (1) anesthetic monitoring in accordance with standards endorsed by the World Federation of Societies of Anesthesiologists; (2) surgical checklists to ensure standardization of care; (3) management practices correlated to patient outcomes; and (4) measurement strategies such as WHO’s proposed standards for surgical surveillance.