thus leakage of bowel contents, as from trauma, substantially increases the risk of infection. Globally, there are few studies comparing perioperative mortality following abdominal surgery across different health systems. One major prospective study of 10,745 adult patients undergoing emergency laparotomy from 357 centres in 58 high-, middle-, and low-income countries found that mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. In this study the overall global mortality rate was 1.6 percent at 24 hours (high 1.1 percent, middle 1.9 percent, low 3.4 percent), increasing to 5.4 percent by 30 days (high 4.5 percent, middle 6.0 percent, low 8.6 percent). Of the 578 patients who died, 404 (69.9 percent) did so between 24 hours and 30 days following surgery (high 74.2 percent, middle 68.8 percent, low 60.5 percent). Patient safety factors were suggested to play an important role, with use of the WHO Surgical Safety Checklist associated with reduced mortality at 30 days. Taking a similar approach, a unique global study of 1,409 children undergoing emergency laparotomy from 253 centres in 43 countries showed that adjusted mortality in children following surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries, translating to 40 excess deaths per 1,000 procedures performed in these settings. Internationally, the most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23)) and middle-HDI (4.42 (1.44 to 13.56)) countries compared with high-HDI countries. Absorption of drugs administered orally was shown to be significantly affected following abdominal surgery. There is low-certainty evidence that there is no difference between using scalpel and electrosurgery in infection rates during major abdominal surgeries. See also Abdominoplasty ASA physical status classification system or perioperative physical fitness Diabetes General surgery Laparotomy Low-fiber/low-residue diet Perioperative mortality References Surgical specialties General surgery