More die after surgery than from HIV, TB, and malaria combined - study

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.

At present, around 4.8 billion people worldwide lack timely access to safe and affordable surgery and it is estimated that there is an annual unmet need for 143 million procedures in LMICs.

For more information or interviews, please contact Tony Moran, International Communications Manager, University of Birmingham on +44 (0) 121 414 8254 or +44 (0)782 783 2312. For out-of-hours enquiries, please call +44 (0) 7789 921 165.

• The University of Birmingham is ranked amongst the world’s top 100 institutions, its work brings people from across the world to Birmingham, including researchers and teachers and more than 6,500 international students from over 150 countries.
• The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
  • Funds, supports and delivers high quality research that benefits the NHS, public health and social care
  • Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
  • Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
  • Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
  • Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
  • The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.
  • NIHR funder the NIHR Global Health Research Unit on Global Surgery built capacity and sustainable surgical research infrastructures in partner LMICs. The Unit working closely together with its UK and LMIC partners to deliver research studies and disseminate the findings.
• For the current 2019 fiscal year, the World Bank defines low-income economies as those with a GNI per capita, calculated using the World Bank Atlas method, of $995 or less in 2017; lower middle-income economies are those with a GNI per capita between $996 and $3,895; upper middle-income economies are those with a GNI per capita between $3,896 and $12,055; high-income economies are those with a GNI per capita of $12,056 or more.

• Funds, supports and delivers high quality research that benefits the NHS, public health and social care
• Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
• Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
• Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
• Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
• The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.
• NIHR funder the NIHR Global Health Research Unit on Global Surgery built capacity and sustainable surgical research infrastructures in partner LMICs. The Unit working closely together with its UK and LMIC partners to deliver research studies and disseminate the findings.