Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Ecological determinants of pathogen infection in howler monkeys

Infectious diseases caused by pathogens are now recognized as one of the most important threats to primate conservation. The fact that howler monkeys (Alouatta spp.) are widely distributed from Southern Mexico to Northern Argentina, inhabit a diverse array of habitats, and are considered pioneers, particularly adapted to exploit marginal habitats, provides an opportunity to explore general trends of parasitism and evaluate the dynamics of infectious diseases in this genus. We take a meta-analysis approach to examine the effect of ecological and environmental variables on parasitic infection using data from 7 howler monkey species at more than 35 sites throughout their distribution. We found that different factors including precipitation, latitude, altitude, and human proximity may infl uence parasite infection depending on the parasite type. We also found that parasites infecting howler monkeys followed a right-skewed distribution, suggesting that only a few individuals harbor infections. This result highlights the importance of collecting large sample sizes when developing these kinds of studies. We suggest that future studies should focus on obtaining fi ne-grained measurements of ecological and microclimate changes to provide better insights into the proximate factors that promote parasitism.Fil: Martinez Mota, Rodolfo. University of Illinois at Urbana-Champaign; Estados UnidosFil: Kowalewski, Miguel Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales "Bernardino Rivadavia". Estación Biológica de Usos Múltiples (Sede Corrientes); ArgentinaFil: Gillespie, Thomas R.. Emory University; Estados Unido

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London