Anaesthetic-related mortality in sub-Saharan Africa - Authors' reply.

www.thelancet.com Vol 381 January 19, 2013 199 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ income countries, we would like to clarify the methods of the study. We combined all of the low-income countries into one subgroup, for the purpose of summarising event rates, on the basis of a predefi ned threshold for “high” versus “low” country development score (see original table 1). However, the more informative analysis comes from our meta-regressions in which we examined risk of death by actual country development score, across the full continuum of development scores provided in the studies (see fi gures 3, 4, 5, 6 in the appendix accompanying the paper). These analyses showed that there was a highly signifi cant relation between decreasing country development score and increasing risk of perioperative or anaesthetic death. It is challenging to identify studies from developing countries if they are published in journals that are not indexed in major medical databases, and if they are published in languages other than English. Nevertheless, these barriers should not be insurmountable in an age of electronic connectivity, and it is our hope that those who are aware of additional studies reporting perioperative and anaesthetic-related mortality in developing countries will be able to notify us through our webpage. We agree that collaborative con nection of global eff orts to better characterise and quantify perioperative mortality in developed and developing countries will improve identifi cation of the most fruitful interventions to reduce risks. We hope that our paper serves as a call to support linkages around the world to help enable this cause.