Introduction: Access to surgical care is an essential element of strengthening health systems. With the recent publication of guidelines by the Lancet Commission, there is a need to consider what access to global surgical care means practically. Given the substantial burden attributable to emergent conditions, the objective of this study was to compare outcomes of emergency surgery patients presenting to a regional tertiary-care hospital in a low-middle income country (LMIC) with outcomes of patients in the United States using coarsened-exact matching (CEM) techniques.
Methods: Patients at the Aga Khan University Hospital (AKUH), Pakistan, were matched to patients in the US Nationwide Inpatient Sample (US-NIS) from 2009 to 2011. Risk-adjusted differences in mortality, major morbidity, and length of stay (LOS) were compared using logistic and generalized-linear (family gamma, link log) models. To account for purported similarities between rural and “global” patients, and the possibility of similarities among teaching institutions in both counties, analogous assessments were conducted among matched cohorts of patients restricted to American rural and urban-teaching locations (Table).
Results: A total of 2,244,486 patients (n=4,867 AKUH; n=2,239,619 US-NIS) were included. Of those in the US-NIS, 990,963 (42.5%) were treated at urban-teaching hospitals, 332,568 (14.3%) in rural locations. Risk-adjusted odds of reported mortality were higher for AKUH patients (odds ratio [OR] [95%CI] 3.80 [2.68-5.37]); odds of reported complications were lower (OR [95%CI] 0.56 [0.48-0.65]). No differences were observed in LOS.
Conclusions: The results demonstrate significant reported morbidity and mortality differences between health care systems. Comparative assessments of global surgical care delivery and detailed consideration of emergent care in various contexts will be essential to support the development and sustainability of meaningful worldwide health-system strengthening.