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

Committee Assignments in the U. S. Senate

Because fundamental control over the legislative process occurs not on the floor but in standing committees, and because assignment to important standing committees increases members\u27 power to control the legislative agenda, congressional committee assignments are important in determining the political and electoral success of incumbents. Changing membership patterns of committees over time provide some clues on the importance of seats on the committees. Using data on committee membership for the U.S. Senate for congresses from World War II to the 103d Congress, we measure the relative value of seats on Senate committees. We assume that senators who transfer from one committee to another are increasing their political and electoral capital. Two different measures developed by Bullock and Sprague and Munger are employed to create an ordering of Senate committee membership prestige. Committee assignment allocation processes in the House of Representatives and the Senate produce similar, expected rankings of legislator preferences among seats on standing committees