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

Diblock copolymer dispersants in polyester powder coatings

Poly(2-vinylpyridine)-b-poly( -caprolactone) copolymers have been used as dispersants for TiO2 pigments in a polyester/TGIC powder coating. In coatings without TGIC, the block copolymer dispersants prevented the flocculation of the TiO2 pigments at typical curing temperatures, by the formation of a steric barrier around the pigment particles. Consequently, non-crosslinked powder coatings with high gloss and excellent flow were obtained. In the presence of TGIC, the dispersants were found to catalyse the crosslinking reaction, leading to powder coatings with lower gloss and poor levelling. By replacing the basic poly(2-vinylpyridine) anchor block of the dispersants with an acidic or neutral anchor group, this undesired effect may be avoided. Alternatively, the poly(2-vinylpyridine)-b-poly( -caprolactone) dispersants are expected to be of special benefit in powder coatings with alternative crosslinking mechanisms, such as UV curable powder coatings

Synthesis and Properties of Di-n-dodecyl α,ω-Alkyl Bisphosphate Surfactants

Three gemini and two bolaform bisphosphate surfactants of the type 12-s-12, with s = 6, 8, 12, 18, and 24 carbon atoms, have been synthesized and their aggregation behavior has been studied. The bolaform surfactants 12-18-12 and 12-24-12 were found to form vesicles in aqueous solution, as indicated by electron microscopy. The geminis 12-6-12, 12-8-12, and 12-12-12 form micellar structures. The cmc’s of the geminis, obtained from conductivity measurements, spectroscopic methods, and microcalorimetry, are very low, on the order of 10-4 to 10-5 M. The cmc decreases with increasing spacer length. For the bolaform amphiphiles 12-18-12 and 12-24-12 noncooperative phase transitions are detected using fluorescence depolarization and DSC. NMR line-broadening studies display unusual behavior. The spacer within the 12-24-12 vesicles has been found to be membrane spanning, as confirmed by X-ray powder diffraction

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

Suomen virallinen tilasto (SVT

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine