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

Reserve estimation of central part of Choghart north anomaly iron ore deposit through ordinary kriging method

This paper is devoted to application of ordinary kriging method in Choghart north anomaly iron ore deposit in Yazd province, Iran. In order to estimate the deposit, 2329 input data gained from 26 boreholes were used. Fe grade was selected as the major regional variable on which the present research has focused. All of the available data were changed to 12.5 m composites so that statistical regularization could be reached. Studies indicated that iron grade input data had single-population characteristics. To carry out ordinary kriging, a spherical model was fitted over empirical variogram. Then the model was verified through cross validation method and proved to be valid with a coherence coefficient of 0.773 between the estimated and real data. Plotting the empirical variogram in different directions showed no geometric anisotropy for the deposit. To estimate the Iron grade, ordinary kriging method was used according to which, all of the exploitable blocks with dimensions 20 m × 20 m × 12.5 m were block estimated within the estimation space. Finally tonnage-grade curve has been drawn and reserve classified into measured, indicated and inferred. Keywords: Choghart north anomaly, Ordinary kriging, Geostatistics, Ore reserve estimatio

Janja Bölgesinde (GD İran) dere sedimanı verilerine dayalı ters mesafe ağırlıklı (IDW) enterpolasyon yöntemi ve konsantrasyon-alan (C-A) fraktal modelleme kullanılarak jeokimyasal anomalilerin ayrılması

Bu çalışmada GD İran’da yer alan Janja Bölgesindeki jeokimyasal anomalilerin belirlenmesi amacıyla ters mesafe ağırlıklı (IDW) enterpolasyon yöntemi ve Konsantrasyon-Alan (C-A) fraktal yöntemleri kullanılmıştır. 300 adet dere sedimanı örneğinden sekiz element (Au, Cu, Mn, Zn, Fe, As, Mo ve Pb) kullanılmıştır. Çalışma alanı 250m x 250m’lik hücreler oluşturacak şekilde karelaj yapılmıştır. Örneklenmemiş alanların tahmini ters kare mesafesi ağırlıklı (IDWS) yönteme göre yapılmıştır. Jeokimyasal haritalar üretilmiştir. Element konsantrasyonlarının kümülatif frekanslarına karşı ilişkili alanlara ait log-log grafi kleri çizilmiştir. Log-log grafi klerindeki kırılma noktaları bulunarak eşik değerleri elde edilmiştir. As, Fe, Mo, Pb ve Zn için dört jeokimyasal popülasyon ve Au, Cu ve Mn için beş jeokimyasal popülasyon bulunmaktadır. Fraktal modellemeden elde edilen jeokimyasal anomali sonuç haritaları, çalışma alanının güneydoğu bölümünde yer alan Zn, Mo, Mn, Fe, Cu ve As anomalilerini göstermiştir. Element anomalileri ve faylar arasında oldukça güzel bir korelasyon oluşmuştur. Buradan hareketle, mineralizasyonun faylar boyunca oluştuğu sonucuna varılabilir.Çalışma alanının GD bölümünde, anomaliler ve sedimanter kayaçlar (alüvyon ve güncel alüvyal çökeller) arasında bir korelasyon vardır. Altın anomalileri, çalışma alanının KB bölümünde yer almaktadır. Çalışma alanının KB bölümünde, Au anomalileri ile fay sistemleri arasında güçlü bir ilişki bulunmaktadır. Demir konsantrasyonları seyrek olup, sedimanter volkanik kayaçlara ve türbiditlere karşılık gelmektedir

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

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally