SynthesisWorld journal of surgery2021
The Impact of Quality Improvement Interventions in Improving Surgical Infections and Mortality in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis.
Synthesis in World journal of surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT06412549 (IMPACTO MR), which is not on this map. Cited by 16 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
IMPACTO MR: Effect of a Bundle of Interventions on Patients With Central Nervous System Devices - Project Platform Supporting the National Action Plan for Prevention and Control of Antimicrobial Resistance
Who cites it
16 citing papers in PubMed, 3 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Effect of interventions on surgical site infections in Sub-Saharan Africa: a systematic review.BMC surgery · 2025Pooled it
- Synthesizing evidence to guide the design and implementation of effective strategies for discontinuing postoperative antibiotic prophylaxis in surgical settings: an umbrella review post-WHO 2018 recommendations.Systematic reviews · 2025Pooled it
- Quality improvement in public-private partnerships in low- and middle-income countries: a systematic review.BMC health services research · 2024Pooled it
- Improving surgical patients' safety in African hospitals: exploring healthcare professionals' experiences of Phase 1 of the '5Rs to Rescue' programme.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Article
- Efficacy of probiotic and synbiotic supplementation on the length of hospital stays and risk of postoperative mortality in patients undergoing surgery: an umbrella review of systematic reviews and meta-analyses of randomized clinical trials.European journal of medical research · 2026Review
- Trends in mortality, pathogen distribution, and antimicrobial resistance of peritoneal and intra-abdominal infections from 1990 to 2021: a cross-sectional analysis of the MICROBE database.International journal of surgery (London, England) · 2025Article
- Surgical safety checklist implementation in a post-armed conflict country with limited resources: the Somali experience.Patient safety in surgery · 2025Article
- Pilot implementation projects in low- and middle-income countries to guide surgical quality improvement using best practice recommendations.Frontiers in health services · 2025Article
- Health systems strengthening through surgical and perioperative care pathways: a changing paradigm.BMJ global health · 2024Review
- Implementation of the WHO surgical safety checklist in resource-limited Somalia: a new standard in surgical safety.Patient safety in surgery · 2024Article
- Antibiotic Stewardship in Surgical Departments.Antibiotics (Basel, Switzerland) · 2024Review
- Trends in birth attendants in Sudan using three consecutive household surveys (from 2006 to 2014).Frontiers in global women's health · 2023Article
- Editorial: Global surgery: the next Frontier in global public health.Frontiers in public health · 2023Article
- Factors associated with surgical site infection in myocardial revascularization: a retrospective longitudinal study.Revista brasileira de enfermagem · 2023Observational
- Systems Analysis and Improvement Approach to optimize the pediatric and adolescent HIV Cascade (SAIA-PEDS): a pilot study.Implementation science communications · 2022Article
- A Simple Infection Prevention 'Bundle' Including Preoperative Bath With Hair-Wash to Reduce Surgical Site Infection (SSI) Following Elective Caesarean and Gynaecological Surgery in India.Journal of family medicine and primary care · 2022Article
Corrections and comments
- Erratum issued
Authors and funding
11 authors at 8 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMorbidity and mortality in surgical systems in low- and middle-income countries (LMICs) remain high compared to high-income countries. Quality improvement processes, interventions, and structure are essential in the effort to improve peri-operative outcomes.
methodsA systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country surgical systems was conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC, occurred in a surgical setting, and measured the effect of an implementation and its impact. The primary outcome was mortality, and secondary outcomes were rates of rates of hospital-acquired infection (HAI) and surgical site infections (SSI). Prospero Registration: CRD42020171542.
resultOf 38,273 search results, 31 studies were included in a qualitative synthesis, and 28 articles were included in a meta-analysis. Implementation of multimodal bundled interventions reduced the incidence of HAI by a relative risk (RR) of 0.39 (95%CI 0.26 to 0.59), the effect of hand hygiene interventions on HAIs showed a non-significant effect of RR of 0.69 (0.46-1.05). The WHO Safe Surgery Checklist reduced mortality by RR 0.68 (0.49 to 0.95) and SSI by RR 0.50 (0.33 to 0.63) and antimicrobial stewardship interventions reduced SSI by RR 0.67 (0.48-0.93).
conclusionThere is evidence that a number of quality improvement processes, interventions and structural changes can improve mortality, HAI and SSI outcomes in the peri-operative setting in LMICs.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.