21 research outputs found
Authoritarianism in Egypt and South Korea : praetorian regimes of Gamal Abdul Nasser and Chung Hee Park
No full textEThOS - Electronic Theses Online ServiceGBUnited Kingdo
Global variation in anastomosis and end colostomy formation following left-sided colorectal resection
No full textnone3427noBackground: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 percent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.noneGlasbey, James C; Adisa, Adewale O; Costas‐Chavarri, Ainhoa; Qureshi, Ahmad U; Allen‐Ingabire, Jean C; Salem, Hosni Khairy; Kojo, Anyomih Theophilus Teddy; Tabiri, Stephen; Nepogodiev, Dmitri; Lilford, Richard J; Harrison, Ewen M; Pinkney, Thomas D; Smart, Neil; Bhangu, Aneel; Verjee, Azmina; Runigamugabo, Emmy; Glasbey, James; Bhangu, Aneel; Ademuyiwa, Adesoji O; Adisa, Adewale O; Aguilera, Maria Lorena; Altamini, Afnan; Alexander, Philip; Al‐Saqqa, Sara W; Borda‐Luque, Giuliano; Cornick, Jen; Costas‐Chavarri, Ainhoa; Drake, Thomas M; Fergusson, Stuart J; Fitzgerald, J Edward; Glasbey, James; Ingabire, J.C Allen; Ismaïl, Lawani; Jaffry, Zahra; Salem, Hosni Khairy; Khatri, Chetan; Kirby, Andrew; Kojo, Anyomih Theophilus Teddy; Lapitan, Marie Carmela; Lilford, Richard; Mihaljevic, Andre L; Mohan, Midhun; Morton, Dion; Mutabazi, Alphonse Zeta; Nepogodiev, Dmitri; Ntirenganya, Faustin; Ots, Riinu; Pata, Francesco; Pinkney, Thomas; Poškus, Tomas; Qureshi, Ahmad Uzair; Medina, Antonio Ramos‐De; Rayne, Sarah; Recinos, Gustavo; Søreide, Kjetil; Shaw, Catherine A; Shu, Sebastian; Spence, Richard; Smart, Neil; Tabiri, Stephen; Lilford, Richard; Morton, Dion; Harrison, Ewen M; Bhangu, Aneel; Khatri, Chetan; Gobin, Neel; Freitas, Ana Vega; Hall, Nigel; Kim, Sung‐Hee; Negida, Ahmed; Khairy, Hosni; Jaffry, Zahra; Chapman, Stephen J; Arnaud, Alexis P; Tabiri, Stephen; Recinos, Gustavo; Manipal, Cutting Edge; Mohan, Midhun; Amandito, Radhian; Shawki, Marwan; Hanrahan, Michael; Pata, Francesco; Zilinskas, Justas; Roslani, April Camilla; Goh, Cheng Chun; Ademuyiwa, Adesoji O; Irwin, Gareth; Shu, Sebastian; Luque, Laura; Shiwani, Hunain; Altamimi, Afnan; Alsaggaf, Mohammed Ubaid; Fergusson, Stuart J; Spence, Richard; Rayne, Sarah; Jeyakumar, Jenifa; Cengiz, Yucel; Raptis, Dmitri A; Glasbey, James C; Modolo, Maria Marta; Iyer, Dushyant; King, Sebastian; Arthur, Tom; Nahar, Sayeda Nazmum; Waterman, Ade; Ismaïl, Lawani; Walsh, Michael; Agarwal, Arnav; Zani, Augusto; Firdouse, Mohammed; Rouse, Tyler; Liu, Qinyang; Correa, Juan Camilo; Salem, Hosni Khairy; Talving, Peep; Worku, Mengistu; Arnaud, Alexis; Tabiri, Stephen; Kalles, Vassilis; Aguilera, Maria Lorena; Recinos, Gustavo; Kumar, Basant; Kumar, Sunil; Amandito, Radhian; Quek, Roy; Pata, Francesco; Ansaloni, Luca; Altibi, Ahmed; Venskutonis, Donatas; Zilinskas, Justas; Poskus, Tomas; Whitaker, John; Msosa, Vanessa; Tew, Yong Yong; Farrugia, Alexia; Borg, Elaine; Medina, Antonio Ramos‐De; Bentounsi, Zineb; Ademuyiwa, Adesoji O; Søreide, Kjetil; Gala, Tanzeela; Al‐Slaibi, Ibrahim; Tahboub, Haya; Alser, Osaid H.; Romani, Diego; Shu, Sebestian; Major, Piotr; Mironescu, Aurel; Bratu, Matei; Kourdouli, Amar; Ndajiwo, Aliyu; Altwijri, Abdulaziz; Alsaggaf, Mohammed Ubaid; Gudal, Ahmad; Jubran, Al Faifi; Seisay, Sam; Lieske, Bettina; Rayne, Sarah; Spence, Richard; Ortega, Irene; Jeyakumar, Jenifa; Senanayake, Kithsiri J.; Abdulbagi, Omar; Cengiz, Yucel; Raptis, Dmitri; Altinel, Yuksel; Kong, Chia; Teasdale, Ella; Irwin, Gareth; Stoddart, Michael; Kabariti, Rakan; Suresh, Sukrit; Gash, Katherine; Narayanan, Ragavan; Maimbo, Mayaba; Fermani, Claudio; Balmaceda, Ruben; Modolo, Maria Marta; Macdermid, Ewan; Gobin, Neel; Chenn, Roxanne; Yong, Cheryl Ou; Edye, Michael; Jarmin, Martin; D'amours, Scott K; Iyer, Dushyant; Youssef, Daniel; Phillips, Nicholas; Brown, Jason; George, Robert; Koh, Cherry; Warren, Oliver; Hanley, Isaac; Dickfos, Marilla; Nawara, Clemens; Öfner, Dietmar; Primavesi, Florian; Mitul, Ashrarur Rahman; Mahmud, Khalid; Hussain, Margub; Hakim, Hafiz; Kumar, Tapan; Oosterkamp, Antje; Assouto, Pamphile A; Lawani, Ismail; Souaibou, Yacoubou Imorou; Tun, Aung Kyaw; Chong, Chean Leung; Devadasar, Giridhar H; Chong, Chean Leung; Qadir, Muhammad Rashid Minhas; Aung, Kyaw Phyo; Yeo, Lee Shi; Chong, Chean Leung; Castillo, Vanessa Dina Palomino; Munhoz, Monique Moron; Moreira, Gisele; De Castro Segundo, Luiz Carlos Barros; Ferreira, Salim Anderson Khouri; Careta, Maíra Cassa; Kim, Stella Binna; De Sousa, Alexandre Venancio; Cury, Alyne Daltri Lazzarini; Miguel, Gustavo Peixoto Soares; De Freitas, Ana Vega Carreiro; Guasti, Barbara Pereira Silvestre Julia; Vianna, Pinto; Felipe, Carolina Oliveira; Laufer, Luis Alberto Valente; Altoe, Fernanda; Da Silva, Luana Ayres; Pimenta, Marina Luiza; Giuriato, Thiago Fernandes; Morais, Paulo Alves Bezerra; Araujo, Jessica Souza Luiz Rafael; Menegussi, Juliana; Leal, Marisa; Lima, Caio Vinícius Barroso; Tatagiba, Luiza Sarmento; Leal, Antônio; Santos, Diogo Vinicius; Fraga, Gustavo Pereira; Simoes, Romeo Lages; Stock, Simon; Nigo, Samuel; Kabba, Juana; Ngwa, Tagang Ebogo; Brown, James; King, Sebastian; Zani, Augusto; Azzie, Georges; Firdouse, Mohammed; Kushwaha, Sameer; Agarwal, Arnav; Bailey, Karen; Cameron, Brian; Livingston, Michael; Horobjowsky, Alexandre; Deckelbaum, Dan L; Razek, Tarek; Marinkovic, Boris; Grasset, Eugenio; D'aguzan, Nicole; Grasset, Eugenio; Jimenez, Julio; Macchiavello, Roberto; Zhang, Zhongtao; Guo, Wei; Oh, Junyeong; Zheng, Fei; Montes, Irene; Sierra, Sebastian; Mendez, Manuela; Villegas, Maria Isabel; Arango, Maria Clara Mendoza; Mendoza, Ivan; Naranjo Aristizã¡bal, Fred Alexander; Botero, Jaime Andres Montoya; Riaza, Victor Manuel Quintero; Restrepo, Jakeline; Morales, Carlos; Arango, Maria Clara Mendoza; Cruz, Herman; Munera, Alejandro; Arango, Maria Clara Mendoza; Karlo, Robert; Domini, Edgar; Mihanovic, Jakov; Radic, Mihael; Zamarin, Kresimir; Pezelj, Nikica; Hache‐Marliere, Manuel; Lemaire, Sylvia Batista; Rivas, Ruben; Khyrallh, Ahmed; Hassan, Ahamed; Shimy, Gamal; Baky Fahmy, Mohamed A; Nabawi, Ayman; Elfil, Mohamed; Ghoneem, Mohamed; Gohar, Muhammad El‐Saied Ahmad Muhammad; Asal, Mohamed; Abdelkader, Mostafa; Gomah, Mahmoud; Rashwan, Hayssam; Karkeet, Mohamed; Gomaa, Ahmed; Hasan, Amr; Elgebaly, Ahmed; Saleh, Omar; Fattah, Ahmad Abdel; Gouda, Abdullah; Elshafay, Abd Elrahman; Gharib, Abdalla; Menshawy, Ahmed; Hanafy, Mohammed; Al‐Mallah, Abdullah; Abdulgawad, Mahmoud; Baheeg, Mohamad; Alhendy, Mohammed; AbdelFattah, Ibrahim; Kenibar, Abdalla; Osman, Omar; Gemeah, Mostafa; Mohammed, Ahmed; Adel, Abdalrahman; Gharib, Abdalla; Mohammed, Abdelrahman; Sayed, Abdelrahman; Abozaid, Mohamed; Kotb, Ahmed Hafez El‐Badri; Ata, Ali Amin Ahmed; Nasr, Mohammed; Alkammash, Abdelrahman; Saeed, Mohammed; El Hamid, Nader Abd; Attia, Attia Mohamed; El Galeel, Ahmed Abd; Elbanby, Eslam; El‐Dien, Khalid Salah; Hantour, Usama; Alahmady, Omar; Mansour, Billal; Elkorashy, Amr Muhammad; Taha, Emad Mohamed Saeed; Lasheen, Kholod Tarek; Elkolaly, Salma Said; Abdel‐Wahab, Nehal Yosri Elsayed; Abozyed, Mahmoud Ahmed Fathi; Adel, Ahmed; Saeed, Ahmed Moustafa; El Sayed, Gehad Samir; Youssif, Jehad Hassan; Ahmed, Soliman Magdy; El‐Shahat, Nermeen Soubhy; Khedr, Abd El‐Rahman Hegazy; Elsebaaye, Abdelrhman Osama; Elzayat, Mohamed; Abdelraheim, Mohamed; Elzayat, Ibrahim; Warda, Mahmoud; El Deen, Khaled Naser; Elnemr, Abdelrhman Essam; Salah, Omar; Abbas, Mohamed; Rashad, Mona; Elzayyat, Ibrahim; Hemeda, Dalia; Tawfik, Gehad; Salama, Mai; Khaled, Hazem; Seisa, Mohamed; Elshaer, Kareem; Hussein, Abdelfatah; Elkhadrawi, Mahmoud; Afifi, Ahmed Mohamed; Ebrahim, Osama Saadeldeen; Metwally, Mahmoud Mohamed; Elmelegy, Rowida; Elsawahly, Diaa Moustafa Elbendary; Safa, Hisham; Nofal, Eman; Elbermawy, Mohamed; Ghazy, Ahmed Abdelmotaleb; Samih, Hisham; Abdelgelil, Asmaa; Abdelghany, Sarah; El Kholy, Ahmed; Aboraya, Metwally; Elkady, Fatma; Salma, Mahmoud; Samy, Sarah; Fakher, Reem; Aboarab, Aya; Samir, Ahmed; Sakr, Ahmed; Haroun, Abdelrahman; Al‐Aarag, Asmaa Abdel‐Rahman; Elkholy, Ahmed; Elshanwany, Sally; Ghanem, Esraa; Tammam, Ahmed; Hammad, Ali Mohamed; El Shoura, Yousra; El Ashal, Gehad; Khairy, Hosni; Antar, Sarah; Mehrez, Sara; Abdelshafy, Mahmoud; Hamad, Maha Gamal Mohamad; Hosh, Mona; Abdallah, Emad; Magdy, Basma; Alzayat, Thuraya; Gamaly, Elsayed; Elfeki, Hossam; Abouzahra, Amany; Elsheikh, Shereen; Elgendy, Fatimah I; El‐Salam, Fathia Abd; Seifelnasr, Osama; Ammar, Mohamed; Eysa, Athar; Sadek, Aliaa; Toeema, Aliaa Gamal; Nasr, Aly; Abuseif, Mohamed; Zidan, Hagar; Barakat, Sara Abd Elmageed; Elsayed, Nadin; Elrasoul, Yasmin Abd; Elkelany, Ahmed; Ammar, Mohamed Sabry; Mustafa, Mennat‐Allah; Hegazy, Yasmin; Etman, Mohamed; Saad, Samar; Alrahawy, Mahmoud; Raslan, Ahmed; Morsi, Mahmoud; Rslan, Ahmed; Sabry, Ahmed; Elwakil, Hager; Shaker, Heba; Zidan, Hagar; Abd‐Elrasoul, Yasmin; Elkelany, Ahmed; El‐Kashef, Hussein; Shaalan, Mohamed; Tarek, Areej; Elwan, Ayman; Nayel, Ahmed Ragab; Seif, Mostafa; Elwan, Ayman; Emadeldin, Doaa; Ghonaim, Mohamed Ali; Almallah, Ahmad; Fouad, Ahmed; Sayma, Eman Adel; Elbatahgy, Ahmad; El‐Ma'doul, Angham Solaiman; Mosad, Ahmed; Tolba, Hager; Elsorogy, Diaa Eldin Abdelazeem Amin; Mostafa, Hassan Ali; Omar, Amira Atef; El Hameed, Ola Sherief Abd; Lasheen, Ahmed; El Salam, Yasser Abd; Morsi, Ashraf; Ismail, Mohammed; El‐badawy, Hager Ahmed; Amer, Mohamed A; Elkelany, Ahmed; Elkelany, Ahmed; El‐Hamouly, Ahmed Sabry; Attallah, Noura A.; Mosalum, Omnia; Afandy, Ahmed; Mokhtar, Ahmed; Abouelnasr, Alaa; Ayad, Sara; Shaker, Ramdan; Sakr, Rokia; Shaker, Ramadan; Amreia, Mahmoud; Elsobky, Soaad; Mustafa, Mohamed; El Magd, Ahmed Abo; Marey, Abeer; Hafez, Amr Tarek; Zalabia, Mohamed F; Mohamed, Mohamed Moamen; Fadel, Amr; Ahmed, Emad Ali; Ali, Ahmad; Alwafai, Mohammad Ghassan; Dwydar, Abdullah; Kharsa, Sara; Mamdouh, Ehab; El‐Sheemy, Hatem; AlYoussef, Ibrahim; Aly, Abouelatta Khairy; Aldalaq, Ahmad; Alnawam, Ehab; Alkhabbaz, Dalia; Saad, Mahmoud; Hussein, Shady; Elazayem, Ahmed Abo; Meshref, Ahmed; Elashmawy, Marwa; Mousa, Mohammed; Nashaat, Ahmad; Ghanem, Sara; Elsayed, Zaynab M; Elwaey, Aya; Elkadsh, Iman; Darweesh, Mariam; Mohameden, Ahmed; Hafez, Mennaallah; Badr, Ahmed; Badwy, Assmaa; El Slam, Mohamed Abd; Elazoul, Mohamed; Al‐Nahrawi, Safwat; Eldamaty, Lotfy; Nada, Fathee; Ameen, Mohamed; Hagar, Aya; Elsehimy, Mohamed; Aboraya, Mohammad; Dawoud, Hossam; El Mesery, Shorouk; El Gendy, Abeer; Abdelkareem, Ahmed; Marey, Ahmed Safwan; Allam, Mostafa; Shehata, Sherif; Abozeid, Khaled; Elshobary, Marwa; Fahiem, Ahmed; Sarsik, Sameh; Hashish, Amel; Zidan, Mohamed; Hashish, Mohamed; Aql, Shaimaa; Elhendawy, Abdelaziz Osman Abdelaziz; Husseini, Mohamed; Kasem, Esraa; Gheith, Ahmed; Elfouly, Yasmin; Soliman, Ahmed Ragab; Ibrahim, Yasmein; Elfouly, Nesma; Fawzy, Ahmed; Hassan, Ahmed; Rashid, Mohammad; Elsherbiny, Abdallah Salah; Sieda, Basem; Badwi, Nermin M; Mohammed, Mohammed Mustafa Hassan; Mohamed, Osama; Habeeb, Mohammad Abdulkhalek; Worku, Mengistu; Starr, Nichole; Desta, Semay; Wondimu, Sahlu; Abebe, Nebyou Seyoum; Thomas, Efeson; Asele, Frehun Ayele; Dabessa, Daniel; Abebe, Nebiyou Seyoum; Zerihun, Abebe Bekele; Mentula, Panu; Leppäniemi, Ari; Sallinen, Ville; Scalabre, Aurelien; Frade, Fernanda; Irtan, Sabine; Graffeille, Vivien; Gaignard, Elodie; Alimi, Quentin; Alimi, Quentin; Graffieille, Vivien; Gaignard, Elodie; Abbo, Olivier; Mouttalib, Sofia; Bouali, Ourdia; Hervieux, Erik; Aigrain, Yves; Botto, Nathalie; Faure, Alice; Fievet, Lucile; Panait, Nicoleta; Eyssartier, Emilie; Schmitt, Francoise; Podevin, Guillaume; Parent, Valentine; Martin, Amandine; Arnaud, Alexis Pierre; Muller, Cecile; Bonnard, Arnaud; Peycelon, Matthieu; Abantanga, Francis; Boakye‐Yiadom, Kwaku; Bukari, Mohammed; Owusu, Frank; Awuku‐Asabre, Joseph; Tabiri, Stephen; Bray, Lemuel Davies; Lytras, Dimitrios; Psarianos, Kyriakos; Bamicha, Anastasia; Kefalidi, Eirini; Gemenetzis, Georgios; Dervenis, Christos; Gouvas, Nikolaos; Agalianos, Christos; Kontos, Michail; Kouraklis, Gregory; Karousos, Dimitrios; Germanos, Stylianos; Marinos, Constantinos; Anthoulakis, Christos; Nikoloudis, Nikolaos; Mitroudis, Nikolaos; Recinos, Gustavo; Estupinian, Sergio; Forno, Walter; Azmitia, José René Arévalo; Cabrera, Carla Cecilia Ramãrez; Guevara, Romeo; Aguilera, Maria; Mendez, Napoleon; Mendizabal, Cesar Augusto Azmitia; Ramazzini, Pablo; Urquizu, Mario Contreras; Tale, Fernando; Soley, Rafael; Barrios, Emanuel; Barrios, Emmanuel; Rodríguez, Daniel Estuardo Marroquín; Velásquez, Carlos Iván Pérez; Mérida, Sara María Contreras; Regalado, Francisco; Lopez, Mario; Siguantay, Miguel; Lam, Fong Yee; Szeto, Kylie Joan‐yi; Szeto, Charing Cheuk Ling; Li, Wing Sum; Li, Kieran Ka Kei; Leung, Man Fung; Mak, Tony; Ng, Simon; Prasad, SS; Kirishnan, Anand; Gyanchandani, Nidhi; Kumar, Bylapudi Seshu; Rangarajan, Muthukumaran; Bhat, Sriram; Sreedharan, Anjana; Kinnera, S.V.; Reddy, Yella; Venugopal, Caranj; Kumar, Sunil; Mittal, Abhishek; Nadkarni, Shravan; Lakshmi, Harish Neelamraju; Malik, Puneet; Limaye, Neel; Pai, Srinivas; Jain, Pratik; Khajanchi, Monty; Satoskar, Savni; Satoskar, Rajeev; Mahamood, Abid Bin; Sutanto, Eldaa Prisca Refianti; Soeselo, Daniel Ardian; Tedjaatmadja, Chintya; Rahmawati, Fitriana Nur; Amandito, Radhian; Mayasari, Maria; Al‐Hasani, Ruqaya Kadhim Mohammed Jawad; Al‐Hameedi, Hasan Ismael Ibraheem; Ibraheem, Hasan Ismael; Al‐Azraqi, Israa Abdullah Aziz; Sabeeh, Lubna; Kamil, Rahma; Shawki, Marwan; Telfah, Muwaffaq Mezeil; Rasendran, Amoudtha; Sheehan, Jacqueline; Kerley, Robert; Normile, Caoimhe; Gilbert, Richard William; Song, Jiheon; Dablouk, Mohamed; Mauro, Linnea; Dablouk, Mohammed Osman; Hanrahan, Michael; Kielty, Paul; Marks, Eleanor; Gosling, Simon; Mccarthy, Michelle; Rasendran, Amoudtha; Mirghani, Diya; Naqvi, Syed Altaf; Wong, Chee Siong; Chung, Siyi; D'cruz, Reuban; Cahill, Ronan; Gosling, Simon George; Mccarthy, Michelle; Rasendran, Amoudtha; Fahy, Ciara; Song, Jiheon; Hanrahan, Michael; Cadogan, Diana Duarte; Powell, Anna; Gilbert, Richard; Clifford, Caroline; Normile, Caoimhe; Driscoll, Aoife; Paul, Stassen; Lee, Chris; Bowe, Ross; Hutch, William; Hanrahan, Michael; Mohan, Helen; O'neill, Maeve; Mealy, Kenneth; Danelli, Piergiorgio; Bondurri, Andrea; Maffioli, Anna; Pasini, Mario; Pata, Giacomo; Roncali, Stefano; Silvani, Paolo; Carlucci, Michele; Faccincani, Roberto; Bonavina, Luigi; Macchitella, Yuri; Ceriani, Chiara; Tugnoli, Gregorio; Di Saverio, Salomone; Khattab, Khaled; Paludi, Miguel Angel; Pata, Domenica; Cloro, Luigi Maria; Allegri, Andrea; Ansaloni, Luca; Coccolini, Federico; Veronese, Ezio; Bortolasi, Luca; Hasheminia, Alireza; Nastri, Giacomo; Canto, Massimiliano Dal; Cucumazzo, Stefano; Pata, Francesco; Benevento, Angelo; Tessera, Gaetano; Grandinetti, Pier Paolo; Maniscalco, Alessio; Lamanna, Giovanni Luca; Turati, Luca; Sgroi, Giovanni; Rausa, Emanuele; Villa, Roberta; Monteleone, Michela; Merlini, David; Coccolini, Federico; Ansaloni, Luca; Allegri, Andrea; Grassi, Veronica; Cirocchi, Roberto; Cacurri, Alban; Waleed, Hamza; Diab, Ahmed; Elzowawi, Fathi; Jokubauskas, Mantas; Varkalys, Karolis; Venskutonis, Donatas; Pranevicius, Robertas; Ambrozeviciute, Viktorija; Juciute, Simona; Skardžiukaitė, Austė; Venskutonis, Donatas; Bradulskis, Saulius; Urbanavicius, Linas; Austraite, Aiste; Riauka, Romualdas; Zilinskas, Justas; Dambrauskas, Zilvinas; Karumnas, Paulius; Urniezius, Zigmantas; Zilinskiene, Reda; Rudzenskaite, Anele; Usaityte, Ausrine; Montrimaite, Margarita; Kaselis, Nerijus; Strazdas, Andrius; Jokubonis, Kristijonas; Maceviciute, Kornelija; Beisa, Virgilijus; Poskus, Tomas; Strupas, Kestutis; Laugzemys, Erikas; Kolosov, Andrej; Jotautas, Valdemaras; Rakita, Ignas; Mikalauskas, Saulius; Kazanavicius, Darius; Rackauskas, Rokas; Strupas, Kestutis; Poskus, Tomas; Beisa, Virgilijus; Rakauskas, Ritauras; Preckailaite, Egle; Coomber, Ross; Johnson, Kenneth; Nowers, Jennifer; Periasammy, Dineshwary; Salleh, Afizah; Das, Andre; Tze, Reuben Goh Ern; Kumar, Milaksh Nirumal; Abdullah, Nik Azim Nik; Kosai, Nik Ritza; Taher, Mustafa; Rajan, Reynu; Chong, Hoong Yin; Roslani, April Camilla; Goh, Cheng Chun; Agius, Marija; Borg, Elaine; Bezzina, Maureen; Bugeja, Roberta; Vella‐Baldacchino, Martinique; Spina, Andrew; Psaila, Josephine; Francois‐Coridon, Helene; Tolg, Cecilia; Colombani, Jean‐Francois; Diaz‐Zorrilla, Carmina; De La Medina, Antonio Ramos‐; Gonzalez, Samantha Corro‐Diaz; Jacobe, Mário; Mapasse, Domingos; Snyder, Elizabeth; Oumer, Ramadan; Osman, Mohammed; Mohammad, Aminu; Anyanwu, Lofty‐John; Sheshe, Abdulrahman; Adesina, Alaba; Faturoti, Olubukola; Taiwo, Ogechukwu; Ibrahim, Muhammad Habib; Nasir, Abdulrasheed A; Suleiman, Siyaka Itopa; Adeniyi, Adewale; Adesanya, Opeoluwa; Adebanjo, Ademola; Osuoji, Roland; Atobatele, Kazeem; Ogunyemi, Ayokunle; Williams, Omolara; Oludara, Mobolaji; Oshodi, Olabode; Ademuyiwa, Adesoji; Lawal, AbdulRazzaq Oluwagbemiga; Alakaloko, Felix; Elebute, Olumide; Osinowo, Adedapo; Bode, Christopher; Adesuyi, Abidemi; Tade, Adesoji; Adekoya, Adeleke; Nwokoro, Collins; Ayandipo, Omobolaji O; Lawal, Taiwo Akeem; Ajao, Akinlabi E; Ali, Samuel Sani; Odeyemi, Babatunde; Olori, Samson; Popoola, Ademola; Adeyeye, Ademola; Adeniran, James; Lossius, William J.; Havemann, Ingemar; Thorsen, Kenneth; Narvestad, Jon Kristian; Soreide, Kjetil; Wold, Trude Beate; Nymo, Linn; Elsiddig, Mohammed; Dar, Manzoor; Bhopal, Kamran Faisal; Iftikhar, Zainab; Furqan, Muhammad Mohsin; Nighat, Bakhtiar; Jawaid, Masood; Khalique, Abdul; Zil‐E‐Ali, Ahsan; Rashid, Anam; Dharamshi, Hasnain Abbas; Naqvi, Tahira; Faraz, Ahmad; Anwar, Abdul Wahid; Yaseen, Tahir Muhammad; Shamsi, Ghina Shamim; Shamsi, Ghina; Yaseen, Tahir; Anwer, Wahid; Decoud, Horacio Paredes; Aguilera, Omar; Alvarez, Ismael Isaac Zelada; Delgado, Juan Marcelo; Vega, Gustavo Miguel Machain; Lohse, Helmut Alfredo Segovia; Aguilar, Wendy Leslie Messa; Chiong, Jose Antonio Cabala; Bautista, Ana Cecilia Manchego; Huaman, Eduardo; Zegarra, Sergio; Camacho, Rony; Celis, Jose María Vergara; Pozo, Diego Alonso Romani; Hamasaki, José; Temoche, Edilberto; Herrera‐Matta, Jaime; Torres, Carla Pierina García; Barreda, Luis Miguel Alvarez; Ojeda, Ronald Renato Barrionuevo; Garaycochea, Octavio; Mollo, Melanie Castro; Delgado, Mitchelle Solange De Fã Tima Linare; Fujii, Francisco; Bautista, Ana Cecilia Manchego; Aguilar, Wendy Leslie Messa; Chiong, Jose Antonio Cabala; Durand, Susana Yrma Aranzabal; Basto, Carlos Alejandro Arroyo; Rojas, Nelson Manuel Urbina; Yip, Sebastian Bernardo Shu; Vergara, Ana Lucia Contreras; Moran, Andrea Echevarria Rosas; Luque, Giuliano Borda; Castro, Manuel Rodriguez; Jaramillo, Ramon Alvarado; Sila, George Manrique; Lopez, Crislee Elizabeth; De Leon, Mardelangel Zapata Ponze; Machaca, Massiell; Huaraya, Ronald Coasaca; Arenas, Andy; López, Crislee; Puma, Clara Milagros Herrera; Pino, Wilfredo; Hinojosa, Christian; De Leon, Melanie Zapata Ponze; Limache, Susan; Sila, George Manrrique; Rodriguez, Layza‐Alejandra Mercado; Melo, Renato; Costa‐Maia, Jose; Muralha, Nuno; Sauvat, Frederique; Dan, Ionasc; Hogea, Mircea; Eduard, Pandi; Bratu, Razvan‐Matei; Beuran, Mircea; Diaconescu, Ionut‐Bogdan; Martian, Bogdan‐Valeriu; Iordache, Florin‐Mihail; Vartic, Mihaela; Vida, Lucian Corneliu; Muntean, Liviu Iuliu; Mironescu, Aurel Sandu; Nsengimana, Vizir Jean Paul; Niragire, Alice; Ingabire, Jean De La Croix Allen; Niyirera, Eugene; Zanini, Nicola; Jovine, Elio; Landolfo, Giovanni; Alomar, Ibrahim N.; Alnuqaydan, Saleh A.; Altwigry, Abdulrahman M.; Othman, Moayad; Osman, Nohad; Alqahtani, Enas; Alzahrani, Mohammed; Alyami, Rifan; Aljohani, Emad; Alhabli, Ibrahim; Mikwar, Zaher; Almuallem, Sultan; Aljohani, Emad; Alyami, Rifan; Alzahrani, Mohammed; Nawawi, Abrar; Bakhaidar, Mohamad; Maghrabi, Ashraf A.; Alsaggaf, Mohammed; Aljiffry, Murad; Altaf, Abdulmalik; Khoja, Ahmad; Habeebullah, Alaa; Akeel, Nouf; Ghandora, Nashat; Almoflihi, Abdullah; Huwait, Abdulmalik; Al‐shammari, Abeer; Al‐Mousa, Mashael; Alghamdi, Masood; Adham, Walid; Albeladi, Bandar; Alfarsi, Muayad Ahmed; Mahdi, Atif; Al Awwad, Saad; Altamimi, Afnan; Nouh, Thamer; Hassanain, Mazen; Aldhafeeri, Salman; Sadig, Nawal; Algohary, Osama; Aledrisy, Mohannad; Gudal, Ahmad; Alrifaie, Ahmad; AlRowais, Mohammed; Althwainy, Amani; Shabkah, Alaa; Alamoudi, Uthman; Alrajraji, Mawaddah; Alghamdi, Basim; Aljohani, Saud; Daqeeq, Abdullah; Al‐Faifi, Jubran J; Jennings, Vicky; Ngayu, Nyawira
Global variation in anastomosis and end colostomy formation following left-sided colorectal resection
No full text3427sinoneBackground: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 percent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.noneGlasbey, James C; Adisa, Adewale O; Costas‐Chavarri, Ainhoa; Qureshi, Ahmad U; Allen‐Ingabire, Jean C; Salem, Hosni Khairy; Kojo, Anyomih Theophilus Teddy; Tabiri, Stephen; Nepogodiev, Dmitri; Lilford, Richard J; Harrison, Ewen M; Pinkney, Thomas D; Smart, Neil; Bhangu, Aneel; Verjee, Azmina; Runigamugabo, Emmy; Glasbey, James; Bhangu, Aneel; Ademuyiwa, Adesoji O; Adisa, Adewale O; Aguilera, Maria Lorena; Altamini, Afnan; Alexander, Philip; Al‐Saqqa, Sara W; Borda‐Luque, Giuliano; Cornick, Jen; Costas‐Chavarri, Ainhoa; Drake, Thomas M; Fergusson, Stuart J; Fitzgerald, J Edward; Glasbey, James; Ingabire, J.C Allen; Ismaïl, Lawani; Jaffry, Zahra; Salem, Hosni Khairy; Khatri, Chetan; Kirby, Andrew; Kojo, Anyomih Theophilus Teddy; Lapitan, Marie Carmela; Lilford, Richard; Mihaljevic, Andre L; Mohan, Midhun; Morton, Dion; 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Tugnoli, Gregorio; Di Saverio, Salomone; Khattab, Khaled; Paludi, Miguel Angel; Pata, Domenica; Cloro, Luigi Maria; Allegri, Andrea; Ansaloni, Luca; Coccolini, Federico; Veronese, Ezio; Bortolasi, Luca; Hasheminia, Alireza; Nastri, Giacomo; Canto, Massimiliano Dal; Cucumazzo, Stefano; Pata, Francesco; Benevento, Angelo; Tessera, Gaetano; Grandinetti, Pier Paolo; Maniscalco, Alessio; Lamanna, Giovanni Luca; Turati, Luca; Sgroi, Giovanni; Rausa, Emanuele; Villa, Roberta; Monteleone, Michela; Merlini, David; Coccolini, Federico; Ansaloni, Luca; Allegri, Andrea; Grassi, Veronica; Cirocchi, Roberto; Cacurri, Alban; Waleed, Hamza; Diab, Ahmed; Elzowawi, Fathi; Jokubauskas, Mantas; Varkalys, Karolis; Venskutonis, Donatas; Pranevicius, Robertas; Ambrozeviciute, Viktorija; Juciute, Simona; Skardžiukaitė, Austė; Venskutonis, Donatas; Bradulskis, Saulius; Urbanavicius, Linas; Austraite, Aiste; Riauka, Romualdas; Zilinskas, Justas; Dambrauskas, Zilvinas; Karumnas, Paulius; Urniezius, Zigmantas; Zilinskiene, Reda; Rudzenskaite, Anele; Usaityte, Ausrine; Montrimaite, Margarita; Kaselis, Nerijus; Strazdas, Andrius; Jokubonis, Kristijonas; Maceviciute, Kornelija; Beisa, Virgilijus; Poskus, Tomas; Strupas, Kestutis; Laugzemys, Erikas; Kolosov, Andrej; Jotautas, Valdemaras; Rakita, Ignas; Mikalauskas, Saulius; Kazanavicius, Darius; Rackauskas, Rokas; Strupas, Kestutis; Poskus, Tomas; Beisa, Virgilijus; Rakauskas, Ritauras; Preckailaite, Egle; Coomber, Ross; Johnson, Kenneth; Nowers, Jennifer; Periasammy, Dineshwary; Salleh, Afizah; Das, Andre; Tze, Reuben Goh Ern; Kumar, Milaksh Nirumal; Abdullah, Nik Azim Nik; Kosai, Nik Ritza; Taher, Mustafa; Rajan, Reynu; Chong, Hoong Yin; Roslani, April Camilla; Goh, Cheng Chun; Agius, Marija; Borg, Elaine; Bezzina, Maureen; Bugeja, Roberta; Vella‐Baldacchino, Martinique; Spina, Andrew; Psaila, Josephine; Francois‐Coridon, Helene; Tolg, Cecilia; Colombani, Jean‐Francois; Diaz‐Zorrilla, Carmina; De La Medina, Antonio Ramos‐; Gonzalez, Samantha Corro‐Diaz; Jacobe, Mário; Mapasse, Domingos; Snyder, Elizabeth; Oumer, Ramadan; Osman, Mohammed; Mohammad, Aminu; Anyanwu, Lofty‐John; Sheshe, Abdulrahman; Adesina, Alaba; Faturoti, Olubukola; Taiwo, Ogechukwu; Ibrahim, Muhammad Habib; Nasir, Abdulrasheed A; Suleiman, Siyaka Itopa; Adeniyi, Adewale; Adesanya, Opeoluwa; Adebanjo, Ademola; Osuoji, Roland; Atobatele, Kazeem; Ogunyemi, Ayokunle; Williams, Omolara; Oludara, Mobolaji; Oshodi, Olabode; Ademuyiwa, Adesoji; Lawal, AbdulRazzaq Oluwagbemiga; Alakaloko, Felix; Elebute, Olumide; Osinowo, Adedapo; Bode, Christopher; Adesuyi, Abidemi; Tade, Adesoji; Adekoya, Adeleke; Nwokoro, Collins; Ayandipo, Omobolaji O; Lawal, Taiwo Akeem; Ajao, Akinlabi E; Ali, Samuel Sani; Odeyemi, Babatunde; Olori, Samson; Popoola, Ademola; Adeyeye, Ademola; Adeniran, James; Lossius, William J.; Havemann, Ingemar; Thorsen, Kenneth; Narvestad, Jon Kristian; Soreide, Kjetil; Wold, Trude Beate; Nymo, Linn; Elsiddig, Mohammed; Dar, Manzoor; Bhopal, Kamran Faisal; Iftikhar, Zainab; Furqan, Muhammad Mohsin; Nighat, Bakhtiar; Jawaid, Masood; Khalique, Abdul; Zil‐E‐Ali, Ahsan; Rashid, Anam; Dharamshi, Hasnain Abbas; Naqvi, Tahira; Faraz, Ahmad; Anwar, Abdul Wahid; Yaseen, Tahir Muhammad; Shamsi, Ghina Shamim; Shamsi, Ghina; Yaseen, Tahir; Anwer, Wahid; Decoud, Horacio Paredes; Aguilera, Omar; Alvarez, Ismael Isaac Zelada; Delgado, Juan Marcelo; Vega, Gustavo Miguel Machain; Lohse, Helmut Alfredo Segovia; Aguilar, Wendy Leslie Messa; Chiong, Jose Antonio Cabala; Bautista, Ana Cecilia Manchego; Huaman, Eduardo; Zegarra, Sergio; Camacho, Rony; Celis, Jose María Vergara; Pozo, Diego Alonso Romani; Hamasaki, José; Temoche, Edilberto; Herrera‐Matta, Jaime; Torres, Carla Pierina García; Barreda, Luis Miguel Alvarez; Ojeda, Ronald Renato Barrionuevo; Garaycochea, Octavio; Mollo, Melanie Castro; Delgado, Mitchelle Solange De Fã Tima Linare; Fujii, Francisco; Bautista, Ana Cecilia Manchego; Aguilar, Wendy Leslie Messa; Chiong, Jose Antonio Cabala; Durand, Susana Yrma Aranzabal; Basto, Carlos Alejandro Arroyo; Rojas, Nelson Manuel Urbina; Yip, Sebastian Bernardo Shu; Vergara, Ana Lucia Contreras; Moran, Andrea Echevarria Rosas; Luque, Giuliano Borda; Castro, Manuel Rodriguez; Jaramillo, Ramon Alvarado; Sila, George Manrique; Lopez, Crislee Elizabeth; De Leon, Mardelangel Zapata Ponze; Machaca, Massiell; Huaraya, Ronald Coasaca; Arenas, Andy; López, Crislee; Puma, Clara Milagros Herrera; Pino, Wilfredo; Hinojosa, Christian; De Leon, Melanie Zapata Ponze; Limache, Susan; Sila, George Manrrique; Rodriguez, Layza‐Alejandra Mercado; Melo, Renato; Costa‐Maia, Jose; Muralha, Nuno; Sauvat, Frederique; Dan, Ionasc; Hogea, Mircea; Eduard, Pandi; Bratu, Razvan‐Matei; Beuran, Mircea; Diaconescu, Ionut‐Bogdan; Martian, Bogdan‐Valeriu; Iordache, Florin‐Mihail; Vartic, Mihaela; Vida, Lucian Corneliu; Muntean, Liviu Iuliu; Mironescu, Aurel Sandu; Nsengimana, Vizir Jean Paul; Niragire, Alice; Ingabire, Jean De La Croix Allen; Niyirera, Eugene; Zanini, Nicola; Jovine, Elio; Landolfo, Giovanni; Alomar, Ibrahim N.; Alnuqaydan, Saleh A.; Altwigry, Abdulrahman M.; Othman, Moayad; Osman, Nohad; Alqahtani, Enas; Alzahrani, Mohammed; Alyami, Rifan; Aljohani, Emad; Alhabli, Ibrahim; Mikwar, Zaher; Almuallem, Sultan; Aljohani, Emad; Alyami, Rifan; Alzahrani, Mohammed; Nawawi, Abrar; Bakhaidar, Mohamad; Maghrabi, Ashraf A.; Alsaggaf, Mohammed; Aljiffry, Murad; Altaf, Abdulmalik; Khoja, Ahmad; Habeebullah, Alaa; Akeel, Nouf; Ghandora, Nashat; Almoflihi, Abdullah; Huwait, Abdulmalik; Al‐shammari, Abeer; Al‐Mousa, Mashael; Alghamdi, Masood; Adham, Walid; Albeladi, Bandar; Alfarsi, Muayad Ahmed; Mahdi, Atif; Al Awwad, Saad; Altamimi, Afnan; Nouh, Thamer; Hassanain, Mazen; Aldhafeeri, Salman; Sadig, Nawal; Algohary, Osama; Aledrisy, Mohannad; Gudal, Ahmad; Alrifaie, Ahmad; AlRowais, Mohammed; Althwainy, Amani; Shabkah, Alaa; Alamoudi, Uthman; Alrajraji, Mawaddah; Alghamdi, Basim; Aljohani, Saud; Daqeeq, Abdullah; Al‐Faifi, Jubran J; Jennings, Vicky;
Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries
No full textBackground: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars (216 compared with 6 (95% confidence interval [CI]: −1) difference in costs. In India, the average cost for high FiO2 was 195 for low FiO2 leading to a −15 to −1164 compared with 93 (95% CI: −65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this. © 2023 The Author
Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study
No full text© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research
Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries
No full text© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit
Global variation in anastomosis and end colostomy formation following left-sided colorectal resection
No full textBackground: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 percent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone
Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries [Elektronisk resurs]
No full textBackground: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. 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), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.AuthorOverflow(1112
Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
No full textBackground Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.
Methods Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.
Results This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. 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), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.
Conclusions Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas
Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey
No full textBackground: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020
