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

Encuentros entre servicios de cirugía de hospitales centenarios en búsqueda de la historia y la tradición científica Meetings among the surgery services of centennial hospitals in search of history and scientific tradition

Los encuentros se realizan de forma anual. El primero se hizo en el Hospital Universitario "Manuel Fajardo", y cuenta en su organización con un colectivo de dirección, que tiene como prioridad la confraternización de los cirujanos y el rescate de la tradición y la historia de la especialidad, para mantener la tradición entre los hospitales y servicios de cirugía centenarios, así como recordar acontecimientos y figuras históricas en la búsqueda de la historia y la tradición científica. El propósito de estos encuentros es homenajear a los profesores con resultados científicos en la docencia médica, motivar el desarrollo de profesionales jóvenes y el reconocimiento a las personalidades históricas fallecidas. Se han efectuado cinco encuentros, entre los que se incluyen cuatro (de conocimientos) entre residentes. Se han realizado reconocimientos a veinticuatro profesores, y se dedicaron los cuatro últimos encuentros de conocimientos a distinguidos profesores fallecidos, en los últimos años. Están integrados cinco hospitales: "Comandante Manuel Fajardo", "General Calixto García", "Dr. Salvador Allende", "Dr. Miguel Enríquez" y "10 de Octubre". Los encuentros entre servicios de cirugía de hospitales centenarios han constituido una fuente de búsqueda de la historia y de reconocimiento al esfuerzo de nuestros profesores.<br>The meetings have an annual base. The first one was in the "Manuel Fajardo" University Hospital and in its organization they have a management group prior whose priority is the brotherhood among the surgeons and the rescue of tradition and history of the specialty, to maintain the tradition among the hospitals and the centennial surgery services, as well as to remember events and historical personalities in the search of the history and the scientific tradition.The purpose of these meetings is to pay tribute to the professors with scientific results in the medical teaching, to motivate the development of young professionals and the recognition to deceased historical personalities. Until now 5 meeting have been developed including four meetings on the resident's knowledges. It has been reconnoitre to 24 professors devoting the last four meeting of knowledges to distinguished deceased professor in past years. Five hospitals are involved: "Comandante Manuel Fajardo", "General Calixto García", "Dr. Salvador Allende", "Dr. Miguel Enríquez" and "10 de Octubre". The meetings among surgery services of centennial hospitals has been a source of search of history and of recognition of the effort in our professors

Letras, 2005-2006, nº 52-53 (número completo)

Contenido: Tras la Edad Media: la retórica del Quijote / Miguel Ángel Garrido Gallardo -- De Montalvo a Montesinos, o el choque de dos mundos (Sargas de Esplandián, 98-99; Quijote, II, 22-23) / Javier Roberto González -- El Quijote y la justicia caballeresca: dilema o realidad / Silvia Cristina Lastra Paz -- Las galas editoriales de un nuevo libro de caballerías: Don Quijote, 1605 / José Manuel Lucía Megías -- La historia del capitán cautivo y la tradición épica de frontera / Alberto Montaner Frutos -- Cervantes lector de Celestina / Joseph Thomas Snow -- La traición de Moriana: el espacio como eje determinantes de moralidad en un romance medieval / Elizabeth A. Augspach -- La hagiografía de clerecía como discurso de la verdad: una revisión del problema / María Cristina Balestrini -- Una etapa de la vida de Don Quijote (II, 20-29). La construcción del personaje y la tradición del viaje como vía sapiencial / Sofía M. Carrizo Rueda -- El discurso profético ficcional de El baladro del sabio Merlín (Burgos, 1498) a partir de la cuestión 171 (Ila Ilae) de la Suma Teológica de Santo Tomás de Aquino / Alejandro Casais -- Nájera y lo caballeresco en Ayala: alcances, límites, intencionalidad / Jorge Norberto Ferro -- Ruptura e integración en la escritura didáctico-narrativa de don Juan Manuel / Leonardo Funes -- La construcción de la autobiografía ejemplar en el “Libro enfenido” de don Juan Manuel / Erica Noemí Janin -- Construcción historiográfica de Zaida en la Crónica General / Gladys Liabe -- El concepto de maravilla en La leyenda del caballero del Cisne de La gran conquista de Ultramar / Mónica Nasif -- La fugada fuga del Beato Aemiliano: originalidad y actualidad en la hagiografía berceana del Santo de la Cogolla / María Reyes Nieto Pérez -- ¿Una Comedia de Calisto y Melibea de 1497? / David Paolini -- La tradición discursiva del exemplum: el capítulo 70 de El Victorial / Santiago Agustín Pérez -- Modos de representación de los animales en el Poema de Fernán González / Alicia A. Ramadori -- Sentido y forma de las llamadas Novelletes sentimentals y su relación con la novela sentimental castellana del siglo XV / Regula Rohland de Langbehn -- Profecía, figura, consumación y Providencia en el Libro de las Tres Razones de Don juan Manuel / Marcelo Rosende -- Acerca del episodio de la efigie del conde Fernán González / Pablo Enrique Saracino -- En torno al Poema de Mio Cid. Poeticidad de la historia. Historicidad del poema / Maximiliano A. Soler Bistué -- Una nueva fuente de Amadís de Gaula: Parzival de Wolfram von Eschenbach / Aquilino Suarez Pallasá -- La emboscada de Roncesvalles / Lía Noemí Uriarte Rebaudi -- La inmensidad de los mundos ficcionales en la compilación de un códice medieval: Ms. Escurialense h-I-13 / Carina Zubillag

Letras, 2005-2006, nº 52-53 (número completo)

Contenido: Tras la Edad Media: la retórica del Quijote / Miguel Ángel Garrido Gallardo -- De Montalvo a Montesinos, o el choque de dos mundos (Sargas de Esplandián, 98-99; Quijote, II, 22-23) / Javier Roberto González -- El Quijote y la justicia caballeresca: dilema o realidad / Silvia Cristina Lastra Paz -- Las galas editoriales de un nuevo libro de caballerías: Don Quijote, 1605 / José Manuel Lucía Megías -- La historia del capitán cautivo y la tradición épica de frontera / Alberto Montaner Frutos -- Cervantes lector de Celestina / Joseph Thomas Snow -- La traición de Moriana: el espacio como eje determinantes de moralidad en un romance medieval / Elizabeth A. Augspach -- La hagiografía de clerecía como discurso de la verdad: una revisión del problema / María Cristina Balestrini -- Una etapa de la vida de Don Quijote (II, 20-29). La construcción del personaje y la tradición del viaje como vía sapiencial / Sofía M. Carrizo Rueda -- El discurso profético ficcional de El baladro del sabio Merlín (Burgos, 1498) a partir de la cuestión 171 (Ila Ilae) de la Suma Teológica de Santo Tomás de Aquino / Alejandro Casais -- Nájera y lo caballeresco en Ayala: alcances, límites, intencionalidad / Jorge Norberto Ferro -- Ruptura e integración en la escritura didáctico-narrativa de don Juan Manuel / Leonardo Funes -- La construcción de la autobiografía ejemplar en el “Libro enfenido” de don Juan Manuel / Erica Noemí Janin -- Construcción historiográfica de Zaida en la Crónica General / Gladys Liabe -- El concepto de maravilla en La leyenda del caballero del Cisne de La gran conquista de Ultramar / Mónica Nasif -- La fugada fuga del Beato Aemiliano: originalidad y actualidad en la hagiografía berceana del Santo de la Cogolla / María Reyes Nieto Pérez -- ¿Una Comedia de Calisto y Melibea de 1497? / David Paolini -- La tradición discursiva del exemplum: el capítulo 70 de El Victorial / Santiago Agustín Pérez -- Modos de representación de los animales en el Poema de Fernán González / Alicia A. Ramadori -- Sentido y forma de las llamadas Novelletes sentimentals y su relación con la novela sentimental castellana del siglo XV / Regula Rohland de Langbehn -- Profecía, figura, consumación y Providencia en el Libro de las Tres Razones de Don juan Manuel / Marcelo Rosende -- Acerca del episodio de la efigie del conde Fernán González / Pablo Enrique Saracino -- En torno al Poema de Mio Cid. Poeticidad de la historia. Historicidad del poema / Maximiliano A. Soler Bistué -- Una nueva fuente de Amadís de Gaula: Parzival de Wolfram von Eschenbach / Aquilino Suarez Pallasá -- La emboscada de Roncesvalles / Lía Noemí Uriarte Rebaudi -- La inmensidad de los mundos ficcionales en la compilación de un códice medieval: Ms. Escurialense h-I-13 / Carina Zubillag

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

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

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 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