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

Luminescence of a Ruthenium Complex Monolayer, Covalently Assembled on Silica Substrates, upon CO Exposure

High quality silica and Si(100) substrates were functionalized with a covalent 4-ClCH(2)C(6)H(4)SiCl(3) monolayer. Additional covalent bonding of an OH-phenol functionalized asymmetric ruthenium complex [Ru(bpy)(2)L](PF(6))(2) to the silylated substrates was further achieved, thus fabricating a new monolayer of ruthenium complex molecules on both silica and Si substrates. The chemical and spectroscopic characterization was carried out by X-ray photoelectron and UV visible spectroscopy measurements. The optical properties of this robust monolayer were studied at room temperature by luminescence measurements in controlled atmosphere. Results grant the system recognition properties for CO at ppm levels. The adopted synthetic procedure has proven to be effective in transferring molecular properties to the solid state thus obtaining a photoluminescent device