Alternative Indicators for Measuring the Impact of Surgical Care Globally: Reply

Excerpt

I read with interest Dr. McQueen’s perspective on measuring the impact of surgical intervention globally [1]. The perioperative mortality rate (POMR) is likely to be a useful initial health indicator for surgical care in selected settings. In the district hospital where we work in rural Rwanda, the in-hospital mortality rate for surgical patients, including those undergoing Cesarean section, was 0.6 % in 2009, making the 24-h postoperative POMR for our hospital nearly zero. As suggested, we have not found the POMR 24 to be a useful metric for our individual program. Of the 800–900 procedures we perform annually, the outcome for the majority is unlikely to be death because of both the nature of the procedures and patient factors. This is despite the fact that more than 50 % of the operations performed are for nonelective indications. A risk-adjusted POMR 24 may be more useful for comparing surgical programs against benchmarks and for monitoring progress over time. The POMR within 30 days postoperatively is unattainable with our current resources and information systems. …