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

Conocimiento y seroprevalencia de Trypanosoma cruzi en perros de Valledupar (Colombia)

Objective. Determine the seroprevalence of IgG antibodies against Trypanosoma cruzi in dogs in the city of Valledupar, department of Cesar in Colombia, as a possible Chagas disease sentinel species. Materials and Methods. An awareness talk was given and a survey applied to participants regarding knowledge, attitudes, practices and risk factors of Chagas disease, previously standardized by the Instituto National de Salud (INS – Colombia). A total of 80 dog samples were tested using an ELISA recombinant Chagatest v3.0. Sample reading was done using an ELISA strip reader Stat Fax 303 Plus and statistical analyses were done with SPSS v.22.0. Results. Data captured by 66 surveys indicates 37.88% of people relate the insect vector and the symptoms with the pathology; most of the surveyed performed vector control at home (cleaning, fumigation). Of the 80 samples evaluated, 95% were negative and 5% positive. No significant association was found between the variables breed, sex and age, and seropositivity to T. cruzi. Conclusions. Identification of seropositive samples in dogs represents an important epidemiological indicator for the Caribbean region and the department of Cesar. Implementation of strategies to strengthen interinstitutional alliances for disease monitoring are recommended, including the use of dogs as sentinel species. This is the first report of seroprevalence of T. cruzi in dogs in the Colombian Caribbean and is expected to increase the knowledge on the behavior of the infection in domestic reservoirs of the region.Objetivo. Determinar la seroprevalencia de anticuerpos IgG contra Trypanosoma cruzi en caninos de la ciudad de Valledupar, en Cesar - Colombia como posible especie centinela de la enfermedad de Chagas. Materiales y métodos. Se realizó una charla de sensibilización y una encuesta con preguntas sobre el conocimiento, actitudes, prácticas y factores de riesgo de la enfermedad de Chagas, estandarizada por el Instituto Nacional de Salud. Se analizaron 80 sueros caninos mediante la técnica Chagatest ELISA recombinante v3.0. La lectura de las muestras se efectuó con el lector de ELISA en tiras Stat Fax 303 Plus y el análisis estadístico se realizó usando SPSS v.22.0. Resultados. Los datos capturados en 66 encuestas indican que 37.88% de las personas relacionan el insecto vector y la sintomatología con la patología; la mayoría de encuestados realizan control de vectores en sus viviendas (limpieza, fumigación). De las 80 muestras evaluadas 95% fueron negativas y 5% positivas. No se encontró relación significativa entre las variables raza, sexo y edad con la seropositividad a T. cruzi. Conclusiones. La identificación de muestras seropositivas en perros representa un indicador epidemiológico importante para la Región Caribe y el departamento del Cesar. Se recomienda implementar estrategias para fortalecer alianzas interinstitucionales en el monitoreo de la enfermedad, incluyendo el uso de perros como centinelas. Este es el primer reporte de serologías caninas positivas para T. cruzi en el Caribe Colombiano por lo que se espera incremente el conocimiento sobre el comportamiento de la infección en reservorios domésticos en la región

Seroprevalencia de Trypanosoma cruzi en perros de Valledupar (Colombia)

Objetivo. Determinar la seroprevalencia de anticuerpos IgG contra Trypanosoma cruzi en caninos de la ciudad de Valledupar, en Cesar - Colombia como posible especie centinela de la enfermedad de Chagas. Materiales y métodos. Se realizó una charla de sensibilización y una encuesta con preguntas sobre el conocimiento, actitudes, prácticas y factores de riesgo de la enfermedad de Chagas, estandarizada por el Instituto Nacional de Salud. Se analizaron 80 sueros caninos mediante la técnica Chagatest ELISA recombinante v3.0. La lectura de las muestras se efectuó con el lector de ELISA en tiras Stat Fax 303 Plus y el análisis estadístico se realizó usando SPSS v.22.0. Resultados. Los datos capturados en 66 encuestas indican que 37.88% de las personas relacionan el insecto vector y la sintomatología con la patología; la mayoría de encuestados realizan control de vectores en sus viviendas (limpieza, fumigación). De las 80 muestras evaluadas 95% fueron negativas y 5% positivas. No se encontró relación significativa entre las variables raza, sexo y edad con la seropositividad a T. cruzi. Conclusiones. La identificación de muestras seropositivas en perros representa un indicador epidemiológico importante para la Región Caribe y el departamento del Cesar. Se recomienda implementar estrategias para fortalecer alianzas interinstitucionales en el monitoreo de la enfermedad, incluyendo el uso de perros como centinelas. Este es el primer reporte de serologías caninas positivas para T. cruzi en el Caribe Colombiano por lo que se espera incremente el conocimiento sobre el comportamiento de la infección en reservorios domésticos en la región.Objective. Determine the seroprevalence of IgG antibodies against Trypanosoma cruzi in dogs in the city of Valledupar, department of Cesar in Colombia, as a possible Chagas disease sentinel species. Materials and Methods. An awareness talk was given and a survey applied to participants regarding knowledge, attitudes, practices and risk factors of Chagas disease, previously standardized by the Instituto National de Salud (INS – Colombia). A total of 80 dog samples were tested using an ELISA recombinant Chagatest v3.0. Sample reading was done using an ELISA strip reader Stat Fax 303 Plus and statistical analyses were done with SPSS v.22.0. Results. Data captured by 66 surveys indicates 37.88% of people relate the insect vector and the symptoms with the pathology; most of the surveyed performed vector control at home (cleaning, fumigation). Of the 80 samples evaluated, 95% were negative and 5% positive. No significant association was found between the variables breed, sex and age, and seropositivity to T. cruzi. Conclusions. Identification of seropositive samples in dogs represents an important epidemiological indicator for the Caribbean region and the department of Cesar. Implementation of strategies to strengthen interinstitutional alliances for disease monitoring are recommended, including the use of dogs as sentinel species. This is the first report of seroprevalence of T. cruzi in dogs in the Colombian Caribbean and is expected to increase the knowledge on the behavior of the infection in domestic reservoirs of the region

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