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

Development of Methods for the Determination of PhACs in Soil/Earthworm/Crop System Irrigated with Reclaimed Water

Pharmaceuticals have been becoming a major concern of environmental pollution since the beginning of the century. The ways in which these contaminants are introduced into the environment are very different, but almost always associated with wastewater. In fact, current wastewater treatment plants are not designed for the removal of pharmaceutical products. Indeed, the problem of water scarcity has played an important role in the introduction of pharmaceutical products into the environment, particularly in the agricultural sector. Because of the drought, more and more countries are resorting to the use of treated wastewater to irrigate vegetables for human consumption. Consequently, the reuse of wastewater in agriculture constitutes a continuous introduction of these molecules into the soil. The effects of this practice are not entirely clear. However, the probability that these compounds can enter the food chain directly is high. In fact, through radical absorption, plants could uptake pharmaceuticals from soil and water, leading to the accumulation of drugs in the tissues. The development of analytical methods of solid matrices such as soil or plant tissues requires substantial work due to the great complexity of the matrices and the differences between the physico-chemical properties of analytes of interest. Several multi-class methods have recently been developed to determine a large number of pharmaceutical products in soil or plants using different extraction techniques. This chapter addresses to list all the analytical procedures published so far used for the extraction and analysis of pharmaceutical products from plant tissues and from the soil irrigated with treated wastewater.This study has been financially supported by the EU through the WaterJPI-2015 AWARE project (PCIN-2017-067). This work was supported by the Spanish Ministry of Science and Innovation (Project CEX2018-000794-S). The authors thank the Water Challenges for a Changing World Joint Programming Initiative.Peer reviewe

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

Kuluttajabarometri maakunnittain 2000, 2. neljännes

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