Perioperative mortality rate (POMR): a global indicator of access to safe surgery and anaesthesia.
BACKGROUND
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.
Deakin University and Barwon Health, Royal Australasian College of Surgeons, 1 Spring Street, Melbourne, VIC, 3000, Australia, watters.david@gmail.com.
David A
DA
Watters
Michael J
MJ
Hollands
Russell L
RL
Gruen
Kiki
K
Maoate
Haydn
H
Perndt
Robert J
RJ
McDougall
Wayne W
WW
Morriss
Viliami
V
Tangi
Kathleen M
KM
Casey
Kelly A
KA
McQueen
D000758:Anesthesia / Q000592:standards*; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006801:Humans; D010351:Patient Discharge; D059035:Perioperative Period / Q000401:mortality*; D019984:Quality Indicators, Health Care; D020379:Risk Adjustment; D013514:Surgical Procedures, Operative / Q000592:standards*; D013997:Time Factors