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

A matched pair analysis of multicenter longterm follow-up after split-liver transplantation with extended right grafts

Split-liver transplantation has been proposed as an alternative to whole liver (WL) transplantation to expand the donor pool, but studies comparing adult longterm outcomes between the 2 methods are conflicting and limited. This is the first Italian multicenter study that retrospectively analyzed 119 matched-pair recipients of whole and extended right grafts (ERGs) for longterm survival outcomes. In the overall population, WL recipients showed higher patient survival at 1 (93% versus 73%), 5 (87% versus 65%), and 10 years (83% versus 60%) after transplantation compared with split-liver recipients (P 50, donor-to-recipient weight ratio < 1, retransplantation status, and United Network for Organ Sharing I-IIA status as risk factors for partial graft use. There were no significant differences in 5-year outcomes based on center volume. In conclusion, we demonstrate that adult liver transplantation with ERGs can achieve longterm success comparable with that of whole grafts in appropriate patients but should be selectively used in patients with risk factors. Liver Transplantation 23 1384\u20131395 2017 AASLD

Why do we need an urban health agenda that prioritizes children and adolescents in Latin America?

Actores de diferentes sectores que trabajamos para mejorar la vida de los niños y adolescentes en las ciudades de América Latina, destacamos la importancia de revisar la agenda de salud urbana priorizando la salud de los niños y adolescentes con vistas a sociedades más equitativas, sostenibles y saludables. Razones para ello se relacionan con la creciente evidencia sobre 1) la relación existente entre los entornos urbanos y las disparidades de salud en las primeras etapas de la vida; 2) el papel clave que jugaron los entornos urbanos para los niños y adolescentes durante las primeras etapas de la pandemia; 3) el potencial que tienen las intervenciones urbanas dirigidas a niños y adolescentes para reducir las disparidades entre ellos y la población urbana en general.Atores de diferentes setores que trabalham para melhorar a vida de crianças e adolescentes nas cidades latino-americanas destacamos a importância de revisitar a agenda de saúde urbana priorizando a saúde de crianças e adolescentes para sociedades mais equitativas, sustentáveis e saudáveis. Fornecemos razões de apoio para isso relacionadas às crescentes evidências sobre 1) a relação entre ambientes urbanos e disparidades de saúde no início da vida; 2) o papel fundamental que os ambientes urbanos desempenharam para crianças e adolescentes durante os primeiros estágios da pandemia; 3) o potencial de intervenções urbanas direcionadas a crianças e adolescentes na redução das disparidades entre eles e a população urbana em geral.As actors from different sectors working on improving children and adolescents’ lives in Latin American cities, we remark the importance of revisiting the urban health agenda prioritizing children and adolescents’ health for more equitable, sustainable, and healthy societies. We provide supporting reasons for this related to the growing evidence on 1) the influence urban environments have on health disparities early in life; 2) the key role urban environments played for children and adolescents during first stages of the pandemic; 3) the potential urban interventions targeted to children and adolescents have on reducing disparities among them and urban population in general.Fil: Ortigoza, A.. Drexel University; Estados UnidosFil: Alazraqui, M.. Universidad Nacional de Lanús. Rectorado. Instituto de Salud Colectiva; ArgentinaFil: Braverman-Bronstein, A.. Drexel University; Estados UnidosFil: Caiaffa, W. T.. Universidad de Mina Gerais; BrasilFil: Cartagena, D.. Drexel University; Estados UnidosFil: Crespo, G.. No especifíca;Fil: Chavez Barriga, V.. No especifíca;Fil: Mazariegos, M.. No especifíca;Fil: Minujin, A.. No especifíca;Fil: Obando, F.. University of Oxford; Reino UnidoFil: Perner, Mónica Serena. Universidad Nacional de Lanús. Rectorado. Instituto de Salud Colectiva; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Sabry, S.. No especifíca;Fil: Vaca Jones, C.. No especifíca;Fil: Vert, C.. Organizacion Mundial de la Salud; Argentin