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| International Surgical Outcomes Study | |
|---|---|
| Name | International Surgical Outcomes Study |
| Abbreviation | ISOS |
| Type | Observational cohort study |
| Established | 2016 |
| Headquarters | International |
| Discipline | Surgery |
International Surgical Outcomes Study The International Surgical Outcomes Study was a large multi-national observational cohort investigating postoperative outcomes after inpatient surgery across numerous countries and institutions. It aimed to map perioperative mortality and morbidity, informing practice in World Health Organization regions, with implications for standards set by organizations like World Federation of Societies of Anaesthesiologists and Royal College of Surgeons of England. The project connected investigators from academic centers affiliated with institutions such as Johns Hopkins Hospital, Massachusetts General Hospital, Guy's and St Thomas' NHS Foundation Trust, and networks including European Society of Anaesthesiology and American College of Surgeons.
The study emerged against a backdrop of global initiatives including Lancet commissions and reports by World Health Organization on surgical safety, and built on prior efforts like the UK National Confidential Enquiry into Patient Outcome and Death and audits by the National Surgical Quality Improvement Program. Primary objectives included quantifying in-hospital mortality, morbidity, and critical care utilization after inpatient surgery in settings ranging from tertiary centers such as Mayo Clinic and Cleveland Clinic to regional hospitals affiliated with Universidade de São Paulo and St George's, University of London. Secondary aims targeted benchmarking for groups like Royal Australasian College of Surgeons, Society of Critical Care Medicine, and International Association for the Study of Pain to inform guidelines by bodies such as National Institute for Health and Care Excellence.
ISOS used prospective cohort methodology modeled after studies like the European Surgical Outcomes Study and registry frameworks employed by National Institutes of Health. Data collection employed standardized case report forms and definitions harmonized with outputs from CONSORT and STROBE guidance. Researchers captured variables including demographics from sites such as Karolinska Institutet and Peking University People's Hospital, procedure types catalogued with references akin to Current Procedural Terminology frameworks, and perioperative interventions per protocols influenced by Enhanced Recovery After Surgery guidelines. Ethical approvals were obtained following processes used at institutions like University of Oxford and University of Cape Town.
The study enrolled thousands of patients across continents, spanning centers in United States, United Kingdom, Brazil, South Africa, India, China, Australia, Germany, France, Italy, Spain, Japan, Canada, Netherlands, Sweden, Norway, Denmark, Belgium, Switzerland, Turkey, Greece, Poland, Portugal, Argentina, Chile, Mexico, Colombia, Egypt, Morocco, Kenya, Nigeria, Tanzania, Thailand, Malaysia, Singapore, Philippines, Indonesia, Vietnam, South Korea, New Zealand, Ireland, Finland, Austria, Czech Republic, Hungary, Romania, Bulgaria, Slovakia, Slovenia, Croatia, Serbia, Ukraine, Belarus, Russia, Saudi Arabia, United Arab Emirates, Israel, Lebanon, Jordan, Qatar, Kuwait, Oman and more. The case mix included general, vascular, orthopedic, gynecologic, and thoracic surgery typical of centers like St Vincent's Hospital Melbourne and Toronto General Hospital, enrolling adult inpatients undergoing elective and emergency procedures with varied American Society of Anesthesiologists classifications used across sites such as Karolinska University Hospital.
Key results highlighted overall in-hospital mortality rates, postoperative complication patterns, and critical care admission rates comparable with findings from the Perioperative Quality Improvement Programme and audits like National Surgical Quality Improvement Program. The study identified variations in outcomes between high-income settings exemplified by Harvard Medical School affiliates and lower-resource centers in line with disparities reported by Global Surgery 2030 advocates. Outcomes included rates of sepsis, cardiac events, respiratory failure, and acute kidney injury with implications for perioperative strategies promoted by European Society of Cardiology and American Society of Anesthesiologists.
Analyses employed multivariable regression models, survival analysis techniques similar to those used in studies from Framingham Heart Study teams, and hierarchical modeling to account for center-level clustering as in research by Institute for Health Metrics and Evaluation. Identified risk factors included age, comorbidities such as diabetes mellitus noted in cohorts from Johns Hopkins Bloomberg School of Public Health, emergency surgery status paralleling findings in National Emergency Laparotomy Audit, and severity indices loosely modeled on APACHE-type scores. Sensitivity analyses referenced methods used in trials published in The New England Journal of Medicine and The Lancet Respiratory Medicine.
Findings influenced recommendations and quality improvement initiatives by organisations such as World Health Organization, Royal College of Surgeons of England, American College of Surgeons, Federation of European Societies for Surgery of the Hand and specialty societies including European Society of Coloproctology and International Society of Perioperative Care. Data informed debates at conferences like American Society of Anesthesiologists Annual Meeting and European Society of Anaesthesiology Congress and contributed evidence used by guideline developers at National Institute for Health and Care Excellence and regional health authorities including NHS England and Centers for Disease Control and Prevention.
Critiques mirrored those lodged against observational registries like the Surgical Care and Outcomes Assessment Program, including selection bias, variable data completeness across centers such as some in Sub-Saharan Africa and heterogeneity in perioperative practices among institutions like Imperial College Healthcare NHS Trust and Beijing Tiantan Hospital. Responding teams invoked robustness checks akin to those in publications from Cochrane Collaboration and revised data-sharing and governance practices informed by frameworks from Committee on Publication Ethics and funders like the Bill & Melinda Gates Foundation to improve representativeness and data quality.
Category:Surgical studies