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

The effects of ethanol on hydrolysis of cellulose and pretreated barley straw by some commercial cellulolytic enzyme products

The effect of ethanol at levels ranging from 2.5% v/v to 15% v/v on the activities of two recently developed commercial cellulosic biomass hydrolytic enzyme products, Accellerase® 1500 and Accellerase® XY, was investigated. The substrates used for study of the effect of ethanol on Accellerase® 1500 included α-cellulose, cellobiose and barley straw pretreated by the soaking in aqueous ammonia method. The initial rates of glucose production and final glucose concentrations obtained at 48 h of hydrolysis were used as the response factors. To study the effect of ethanol on Accellerase® XY, beechwood xylan and the pretreated barley straw were used as substrates. The response factors included the initial rates of xylose production and final xylose concentrations obtained at 48 h of hydrolysis. It was found that ethanol acted as either activator or inhibitor depending on its concentration and the type of substrate used. At 10% v/v, which is expected to be the final concentration of ethanol in a commercial cellulosic biomass-based process, ethanol acted as an inhibitor in all cases. However, even at this ethanol level, both commercial enzymes still retained at least about 50% of their activities

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London