Adil A Shah1, Cheryl K Zogg2, Abdul Rehman3, Asad Latif4, Hasnain Zafar3, Amarah Shakoor5, Nabil Wasif6, Alyssa B Chapital6, Robert Riviello7, Awais Ashfaq8, Mallory Williams9, Edward E Cornwell9, Adil H Haider10. 1. Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA; Division of General Surgery, Mayo Clinic, Phoenix, AZ, USA; Department of Surgery, Aga Khan University, Karachi, Pakistan. 2. Yale University, School of Medicine, New-Haven, CT, USA; Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA. 3. Department of Surgery, Aga Khan University, Karachi, Pakistan. 4. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 5. Charleston Area Medical Center, West Virginia University, Charleston, WV, USA. 6. Division of General Surgery, Mayo Clinic, Phoenix, AZ, USA. 7. Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA. 8. Department of Cardiothoracic Surgery, Oregon Health Sciences University, Portland, OR, USA. 9. Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA. 10. Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA. Electronic address: ahhaider@partners.org.
Abstract
INTRODUCTION: Access to surgical care is an essential element of health-systems strengthening. This study aims to compare two diverse healthcare settings in South Asia and the United States (US). METHODS: Patients at the Aga Khan University Hospital (AKUH), Pakistan were matched to patients captured in the US Nationwide Inpatient Sample (US-NIS) from 2009 to 2011. Risk-adjusted differences in mortality, major morbidity, and LOS were compared using logistic and generalized-linear (family gamma, link log) models after coarsened-exact matching. RESULTS: A total of 2,244,486 patients (n = 4867 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 Pakistani patients (OR[95%CI]: 3.80[2.68-5.37]), while odds of reported complications were lower (OR[95%CI]: 0.56[0.48-0.65]). No differences were observed in LOS. The difference in outcomes was less pronounced when comparing Pakistani patients to American rural patients. CONCLUSION: These results demonstrate significant reported morbidity, mortality differences between healthcare systems. Comparative assessments such as this will inform global health policy development and support.
INTRODUCTION: Access to surgical care is an essential element of health-systems strengthening. This study aims to compare two diverse healthcare settings in South Asia and the United States (US). METHODS:Patients at the Aga Khan University Hospital (AKUH), Pakistan were matched to patients captured in the US Nationwide Inpatient Sample (US-NIS) from 2009 to 2011. Risk-adjusted differences in mortality, major morbidity, and LOS were compared using logistic and generalized-linear (family gamma, link log) models after coarsened-exact matching. RESULTS: A total of 2,244,486 patients (n = 4867 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 Pakistani patients (OR[95%CI]: 3.80[2.68-5.37]), while odds of reported complications were lower (OR[95%CI]: 0.56[0.48-0.65]). No differences were observed in LOS. The difference in outcomes was less pronounced when comparing Pakistani patients to American rural patients. CONCLUSION: These results demonstrate significant reported morbidity, mortality differences between healthcare systems. Comparative assessments such as this will inform global health policy development and support.