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

Study of heavy metal levels in seawater in the vicinity of Single Buoy Moorings at Mina Al Fahal, Sultanate of Oman

This study was conducted to determine the concentrations of cadmium, copper, lead, and vanadium in seawater samples taken from the vicinity of Single Buoy Mooring 3 (SBM3) at Mina Al Fahal in the Sultanate of Oman. SBM3 is one of three locations at Mina Al Fahal (SBM1 and SBM2) associated with importing and exporting refined petroleum products. Using graphite furnace atomic absorption spectrophotometry, concentrations of these four metals in seawater samples were measured in six samples. None of the metals was present in concentrations greater than the European Commission/United Kingdom Environmental Quality Standards, but a comparison to previous data collected at SBM2 indicates that concentrations have increased approximately 40% over the past two decades. To better identify sources of the metals, it is imperative to monitor effluents and collect more targeted samples at and/or near discharge points

Fabrication of polyethersulfone electrospun nanofibrous membranes incorporated with hydrous manganese dioxide for enhanced ultrafiltration of oily solution

In this work, a new type of ultrafiltration (UF) electrospun nanofibrous membranes (ENMs) incorporating hydrous manganese dioxide (HMO) nanoparticles was fabricated with the objective of improving properties of polyethersulfone (PES)-based membrane for synthetic oily solution treatment. Two treatments were carried out to improve the mechanical property and hydrophilicity of the PES-based membrane without compromising its porosity and water permeance. The first treatment involved the use of mixed solvents – dimethylformamide and n-methyl-pyrrolidinone (DMF/NMP) in which NMP is a high vapor pressure component that could enhance the mechanical properties of the nanofibrous by improving solvent-induced fusion of inter-fiber junction points. The second treatment involved the incorporation of specific amount of HMO nanoparticles in PES dope solution to enhance membrane hydrophilicity. Heat treatment was also adopted as an effective approach to strengthen and prevent delamination of the nanofibrous mat during UF process. The HMO-incorporated ENMs exhibited an excellent oil rejection (97.98% and 94.04%) and a promising water flux recovery (89.29% and 71.10%) when used to treat a synthetic oily solution containing 5000 or 10,000 ppm oil, respectively. The best promising HMO-incorporated ENM exhibited much higher magnitude of water productivity (>7000 L/m2h) without sacrificing oil removal rate. Most importantly, this nanofillers-incorporated membrane showed significantly lower degree of flux decline as a result of improved surface resistance against oil fouling and is of potential for long-term operation with extended lifespan. The promising mechanical and anti-fouling properties of the ENMs is potentially applicable in the efficient industrial oily effluents treatment when challenged with oil-in-water emulsions

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