The need for a joint response. Perioperative mortality in Latin America and the time for LASOS Study

Abstract

We need more than 100 million additional surgical procedures each year in lowand middle-income countries (LMICs) to achieve safe, timely and affordable surgery at population level (1, 2). As with any human system, perioperative and medical health care have inherent risks that can vary among populations, including between and within countries, specific settings, and individual providers. Indeed, increasing the volume of surgical activity includes expecting an increase in complications and deaths after surgery, especially in fragile perioperative health systems (3). Perioperative mortality has declined significantly over the past 50 years, with the greatest decline in developed high-income countries, (4) but there has been a paucity of epidemiological research to describe perioperative mortality and complications after surgery, especially in LMICs (5). Latin America includes 33 countries and 14 territories, with a huge diversity in socio-cultural factors, ethnicity, geography, and political systems. These in turn, lead to widespread differences in healthcare provision and the population of patients who require surgery. As an example, Colombia is a predominantly urban country (76% of the population) of over 48 million inhabitants (6) with a widespread variability in the surgical systems across the country. Urban settings show top-quality hospitals and educational programs while rural remote locations have a deficient, fragmented, and disorganized healthcare provision (5). Recent studies have recognized the critical importance of social deprivation and population inequities as risk factors for poor patient outcomes after surgery, (7,8) including timely and affordable access to elective surgical care (9). The availability of objective and robust data allowed clinicians, researchers, and healthcare policymakers to focus on the issues of greatest importance to our patients and contextualize our populations in terms of needs, and availability of surgical services. Nevertheless, in LMICs the large size of the surgical population makes longitudinal epidemiological studies difficult or impossible to be conducted. Routine national datasets are either unavailable or not accessible, and there is little or no research delivery workforce to collect source data. In addition, several barriers to promoting collaborative research have been identified including language barriers, the frailty of health care systems, inappropriate data registries, limitations with approvals from ethical committees and individualism and selfishness in research (10). However, previous collaborative studies during the COVID-19 pandemic were successfully conducted (CovidSurg, CovidSurg-Cancer, CovidSurg Week and CovidSurg 3), including many Latin American countries with a very important number of hospitals, professionals and OPEN