A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background 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

Place de la luxation congenitale de hanche parmi les malformations congenitales cliniquement visibles chez les nouveau-nes a Cotonou

Introduction : La Luxation Congénitale de Hanche (LCH), problème de santé publique en Occident a une incidence variable d’une région à l’autre, allant de 20%0 naissances en France à 188,5%0 naissances au Canada. Sa rareté en Afrique noire s’expliquerait par le port habituel du bébé africain au dos. Notre travail a pour but d’évaluer l’incidence de la LCH au sein des malformations congénitales cliniquement visibles et en rechercher les facteurs de risque.Méthode : Il s’agit d’une étude prospective d’une durée de 06 mois, concernant des nouveau-nés jamais portés au dos, examinés dans 4 maternités de Cotonou (Bénin).Résultats : Sur 2030 nouveau-nés noirs examinés dans (04) quatre maternités de Cotonou, 54 d’entre eux (2,66%) portaient une ou plusieurs malformations congénitales. L’âge moyen des nouveau-nés malformés était de 2 jours ±1,76 et le sex-ratio M/F était égal à 1,19. Les malformations des membres étaient les plus fréquentes (63,93%), puis venaient les malformations du tube neural (11,48%), urogénitales (11,48%), de la face et de la cavité buccale (9,83%) et du système digestif (3,28%). Toutes les hanches des nouveau-nés ont été examinées par les manoeuvres d’Ortolani et de Barlow. Nous n’avons objectivé aucun cas de hanche luxée, ceci même chez les nouveau-nés (77,04%) qui présentaient un ou plusieurs facteurs de risque de LCH après trois examens cliniques minutieux et échographie de hanche.Conclusion : Le port habituel des bébés africains au dos n’est donc pas un facteur déterminant pour expliquer la rareté de cette affection. Elle serait probablement le fait de prédispositions génétiques. Mots clés : Luxation, hanche, malformations, nouveau-né, Bénin English Abstract: Place of congenital hip dislocation among congenital malformations clinically visible in neonates in Cotonou Background: Congenital Dislocation of the Hip (CDH) is a public health problem in developed countries. His incidence varies from one area to another,with 20%0 births in France and 188,5%0 births in Canada. The usual port on the back of babies would explain the rarity of this disease in Africa. We have assessed the incidence of CDH in clinically visible congenital malformations and seek risk factors.Method: It is a prospective study during 06 months, concerning neonatal never brought back, examined in 4 maternity of Cotonou (Bénin).Results: After 2030 black neonates hips examinations, we did not find any dislocated hip, neither in newborns (77.04%) who had one or more risk factors for CDH, nor in those who had one or more congenital malformations (54; 2.66%). The average age of malformed infants was 2 days ± 1.76 and the sex ratio was 1.19. The limb defects were the most frequent (63.93%), followed by the defects of neural tube (11.48%), urogenital system (11.48%), face and oral cavity (9.83%) and digestive system (3.28%).Conclusion: The CDH is not a black African disease. The usual port on the back of babies is not a determining factor to explain the rarity of this disease in Africa. It would probably be the fact of genetic or environmental predisposition that would be elucidated by further work. Keywords: dislocation, hip, malformation, newborn, Béni

Perforation gastrique médicamenteuse chez l’enfant : une complication rare, à propos d’un cas

La perforation gastrique est une complication redoutable après ingestion médicamenteuse. Elle constitue une urgence rare mais potentiellement mortelle chez l’enfant. Nous rapportons un cas exceptionnel chez une fillette de 03 ans, sans antécédents particuliers, reçue en urgence pour des douleurs abdominales généralisées, apparues de façon brutale, après usage de tisanes et d’anti inflammatoire, associées à des vomissements verdâtres et à un arrêt des matières et des gaz. L’examen physique avait noté un syndrome infectieux et un syndrome d’irritation péritonéale permettant d’évoquer une péritonite aigue généralisée. En per opératoire, l’exploration avait permis de confirmer le diagnostic préopératoire et de retrouver une perforation antrale. La fillette avait été l’objet d’une excision – suture des berges de la perforation. L’examen anatomopathologique de la pièce opératoire avait objectivé des lésions de gastrite périulcéreuse sans métaplasie. Les suites opératoires étaient simples. Une thérapie relative à l’éradication de l’Hélicobacter pylori avait été institué. L’examen clinique était normal avec un recul de 1 an.Mots clés: perforation, gastrique, anti-inflammatoire, enfantEnglish AbstractGastric perforation is a dreadful complication of drug ingestion.It is a rare,but potentially fatal emergency in children.We report the case of the a 3-year-old girl with no relevant past history received as an emergency for genetalised abdominal pain. The pain was of sudden onset,following the intake of infusions and anti-inflammatory drugs for a fever. It became associated with a greenish vomitus and cessation of stool and flatus passage. The physical examination revealed an infectious syndrome and features of peritoneal irritation, leading to the diagnosis of acute generalised peritonitis. Intraoperatively,exploration confirmed the diagnosis and sited an antral perforation. She benefitted from an excision and suturing of the borders of the perforation.The histopathological examination of the borders concluded to lesions consistent with a periulcerative gastritis with no metaplasia. The postoperative period was uneventful. She received a Helicobacter Pylori éradication therapy.A year later the clinical examination was normal.Keywords: Perforation, gastric, anti-inflammatory, childre

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 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