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Sometimes the cure is worse than the disease

Janet Martin is a professor at Western University. [Submitted]

A new study by a local researcher offered a disturbing discovery about the global death toll, finding surgeries intended to save lives may just cost them instead.

Approximately 4.2 million people die within 30 days after surgery every year, making that the third-leading cause of death worldwide.

This number exceeds total deaths caused from infectious diseases including tuberculosis, HIV and malaria at 2.97 million, found the article co-written by Hawkesville native Janet Martin, an associate professor at the Schulich School of Medicine & Dentistry at Western University.

“The degree to which this has been flying under the radar surprised me,” said Martin. “But now that we have these numbers, it’s almost like it’s time for a global outrage. Just to say ‘Whoa. We actually need to sit up and pay attention to this.’”

“Surgery has been the ‘neglected stepchild’ of global health and has received a fraction of the investment put into treating infectious diseases such as malaria,” added Dmitri Nepogodiev, research fellow at the University of Birmingham in the United Kingdom and co-author on the paper.

The University of Western and University of Birmingham researchers also collaborated with the University of Cape Town in South Africa to publish the research findings in one of the world’s leading medical journals, the Lancet, in early February.

In particular, low- and middle-income countries account for approximately 50 per cent of the postoperative surgical deaths, where surgery is less accessible. About 313 million operations are performed each year, making the mortality rate 30 days after surgery at 0.013 per cent.

“We really think that it’s such a preventable problem and such an easy solution in many cases,” said Martin, a graduate of Elmira District Secondary School. “It’s not rocket science. The fact is that there hasn’t been a lot of attention on it.

“We know [solutions] are possible because we’ve implemented them in our high-income countries. And we’ve brought the risk of mortality down to really low levels in high-income countries where these systems are adequately implemented.”

The research took all types of surgeries that require a patient to undergo anaesthesia into account – for example, dental surgeries and minor skin surgeries would not apply.

“The most common type of surgical emergency that arises worldwide is the need for C-sections,” said Martin. “There you have a critical situation and if you don’t have supplies on hand to keep the mother resuscitated or to resuscitate her if she starts losing blood – so you need some type of blood bank supply and fluid supply intravenously to manage.”

She also stressed the importance of having sterile surgical equipment on hand for that type of situation – straightforward measures that would have a huge impact globally.

“Our goal is to have surgery as safe and effective as possible and to have good decision-making up front, so we know how to minimize all of those risks going in,” said Martin. “And if the risk is too great, then to reconsider if surgery is the best option in the first place. That’s another really heated set of decisions that need to be better researched.”

Currently, an estimated 4.8 billion people lack timely access to safe and affordable surgery worldwide. There is an annual unmet need for some 143 types of procedures in low- and middle-income countries.

While it used all the publicly available information data that was available to estimate these rates, reports of postoperative deaths are only available for 29 countries.

“We had to use data that was available,” said Martin. “There’s a limited number of countries around the world that makes this data accessible. It really varies when we break it down by individual types of surgery, because some individual types of surgeries have much greater variation in the risk of mortality within 30 days.”

The leading cause of death worldwide is due to ischaemic heart disease at 9.4 million, followed by stroke at 5.8 million.

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