Perioperative medicine & outcomes
Barriers to Quality Perioperative Care and Postoperative Mortality Variations in Elective Abdominal Surgery: A Mixed-Methods Study
Authors' conclusion
The primary challenges in delivering high-quality care were identified during the postoperative period, significantly affecting patient outcomes.
Study context
- Population
- Patients undergoing elective abdominal surgery at 10 hospitals in Brazil
- Participants
- 107,372 patients · 10 hospitals
- Exposure
- Hospitals associated with higher vs lower postoperative mortality
- Outcome
- 30-day postoperative mortality variation attributable to hospital effects
- Follow-up
- 30-day
Methodological detailssecondary cohort data (ExCareBR), rapid qualitative assessment, multilevel model
- Secondary cohort data (ExCareBR)
- Rapid qualitative assessment
- Multilevel model
Main finding
As reported in the abstract
Hospital-level variability in 30-day postoperative mortality
Median odds ratio (MOR), adjusted for patient and procedure factors
1.58
IQR 1.47–1.70
Observational data: associations, not effects.
Further findings
Barriers to quality care distinguishing higher-mortality hospitals (qualitative)
- Lack of standardised organisational structures for postoperative care, impeding escalation of care
- Nurse understaffing in surgical wards
- Communication deficiencies across perioperative phases
- Fragmented perioperative patient pathways within the public health system
Original publication
Barriers to Quality Perioperative Care and Postoperative Mortality Variations in Elective Abdominal Surgery: A Mixed-Methods Study. Anesth Analg. Published 25 September 2026. doi:10.
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