Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Hubungan Kadar Seng dan vitamin A dengan Kejadian ISPA dan Diare pada Anak

Latar belakang. Rendahnya sistem imunitas dianggap turut berpengaruh terhadap kejadian ISPA dan diare. Beberapa penelitan menyatakan bahwa kadar seng dan vitamin A dalam serum yang rendah juga berpengaruh terhadap sistim imun. Tujuan.Untuk mengetahui hubungan antara status seng dan vitamin A dengan kejadian ISPA dan diare pada anak. Metode. Penelitian kohort selama enam bulan di lima posyandu di wilayah kerja Puskesmas Talang Ratu, Palembang. Subjek penelitian adalah anak berumur 12-60 bulan yang datang ke Posyandu pada bulan Februari 2009. Kadar seng dan vitamin A diperiksa, serta mendapat vitamin A sesuai program pemerintah. Data ISPA dan diare dari subjek, dikumpulkan selama 6 bulan dan selanjutnya dianalisis dengan program SPSS 15. Hasil. Terdapat 100 subjek ikut dalam penelitian, namun 8 subjek tidak melanjutkan, sehingga terdapat 92 subjek. Ditemukan 62% mengalami defisiensi seng dan 68,5% defisiensi vitamin A. Didapatkan hubungan yang bermakna antara defisiensi seng dan vitamin A (RR=5,833;KI 95%:2,816-12,085). Selama 6 bulan didapatkan 62% subjek menderita ISPA dan 30,4% menderita diare. Terdapat hubungan yang bermakna kejadian ISPA dengan anak defisiensi seng dan atau vitamin A (RR=2,455;KI 95%:1,403-4,297). Ditemukan juga hubungan yang bermakna pada kejadian diare dengan anak defisiensi seng dan atau vitamin A (RR=5,984;KI 95%:1,522-23,534). Kesimpulan. Status seng dan vitamin A merupakan faktor yang mempengaruhi kejadian ISPA dan diare pada anak

Dampak Usia Pertama Pemberian Makanan Pendamping Asi Terhadap Status Gizi Bayi Usia 8-12 Bulan di Kecamatan Seberang Ulu I Palembang

Latar belakang. Pemberian makanan pendamping ASI (MPASI) dini sebelum usia enam bulan akan menyebabkan bayi rentan mengalami penyakit infeksi dan alergi, sehingga dapat mengakibatkan malnutrisi dan gangguan pertumbuhan. Tujuan. Menilai hubungan antara usia pertama pemberian MPASI terhadap status gizi bayi usia 8-12 bulan. Metode. Penelitian kasus-kontrol dilakukan pada bulan 1 Februari-30 April 2012 di Puskesmas dan Posyandu di Kecamatan Seberang Ulu I Palembang. Sampel didapatkan secara consecutive sampling, dan dikelompokkan sebagai kelompok kasus dengan gizi kurang dan kelompok kontrol dengan gizi baik yang memenuhi kriteria inklusi. Semua subjek dilakukan penelusuran retrospektif mengenai usia pertamakali diberikan MPASI. Hasil. Telah diteliti 240 subyek terdiri dari 80 subyek dengan gizi kurang dan 160 subyek dengan gizi baik. Hasil analisis chi-square dalam mencari hubungan antara usia pertama pemberian MPASI terhadap status gizi menunjukkan OR 1,42 dengan 95% CI antara 0,8-2,4 (p=0,2). Kesimpulan. Pemberian MPASI dini tidak berhubungan dengan status gizi pada usia 8-12 bulan