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Patients with abdominal trauma are three times more likely to die after emergency surgery in the world’s least developed countries than those in the most developed nations, a new study led by a St John’s College researcher has found.

Yet among those who undergo surgery for incidents such as road traffic accidents, stabbings, or gunshot wounds, injuries tend to be less severe – raising concerns those most critically injured are not even reaching the operating theatre.

The research published in  has revealed stark global inequalities in survival after emergency abdominal surgery for traumatic injuries.

Dr Michael Bath, lead author and PhD student at St John’s College, whose work is based in the University of Cambridge’s Department of Engineering, said: “Our findings point to a survival gap that begins before patients even reach the operating theatre.

“This may be because the most seriously injured die before they can access life-saving care, or because limitations in diagnosis mean their injuries go undetected.”

The study is Dr Bath’s main research project from his PhD in Engineering, which focuses on better understanding trauma care provision worldwide and developing trauma systems in resource-limited settings.

It found that patients in the world’s least developed countries face a substantially higher risk of dying within 30 days of surgery than those in the most developed nations, as ranked by the United Nations Human Development Index (HDI).

Although overall mortality rates appeared similar across settings at 11 per cent, risk-adjusted analysis showed patients in the lowest-HDI countries faced more than three times the risk of death compared with those in the highest-HDI group, while the risk in middle-HDI countries was nearly double.

The Global Outcomes After Laparotomy for Trauma(GOAL-Trauma) study was led by the University of Cambridge and carried out by a global network of collaborators. It analysed data from 1,769 patients treated in 187 hospitals across 51 countries, ranging from conflict-affected areas such as the Occupied Palestinian Territories, Ukraine, and Sudan to well-resourced trauma centres in Europe and the United States.

All patients had undergone a trauma laparotomy – emergency surgery to repair internal abdominal injuries – as a result of incidents such as road traffic accidents, stabbings, or gunshot wounds.

The study also found wide disparities in hospital care. The researchers call for coordinated improvements across the entire trauma pathway– from the moment of injury to full recovery – to ensure critically injured patients receive the treatment they need.

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