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

Separation of Radioactive Elements from Ethiopian Kenticha Pegmatite Ore by Hydrometallurgical Methods

The leaching and extraction behavior of uranium and thorium from a high-grade Ethiopian pegmatite ore in a mixture of hydrofluoric acid and sulfuric acid has been investigated. The effects of variables such as the temperature, particle size, acid concentration, and leaching time were studied. The leaching efficiency of uranium increased with increasing temperature to 150°C, at which 96% removal of uranium was achieved. Particles in the size range of − 100 + 75 μm resulted in the highest leaching of uranium, while formation of a colloidal suspension was observed when using a fine particle size fraction (− 75 μm). The dissolution of uranium increased with increasing leaching time. No significant systematic dependence of the leachability of thorium on the above variables was observed. Optimum extraction of uranium and thorium using D2EHPA was obtained when using aqueous/organic phase volume ratio of 1:1, solvent concentration of 0.3 M, and contact time of 20 min