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

Effectiveness of binary combinations of Plectranthus glandulosus leaf powder and Hymenocardia acida wood ash against Sitophilus zeamais (Coleoptera: Curculionidae)

Abstract Background Botanicals are generally assumed to be more biodegradable, leading to less environmental problems. Combination of botanicals could enhance biological activity against insect pests. Hence, the amount of botanical used for the control of stored grain pests may be minimised. In this study, the bioassay was carried out on Sitophilus zeamais to assess the effectiveness of binary combinations of Hymenocardia acida wood ash and Plectranthus glandulosus leaf powder. The quantities of mixed products were added to maize grains to constitute the contents of 5, 10, 20 and 40 g/kg. Then, the bioassays on toxicity within 1, 3, 7 and 14 days exposure, progeny production, population increase, grain damage and germination ability of protected grains were carried out. Results The major compounds (pinene, α-pinene, α-terpineol, thymol, β-myrcene and 3-carene) of P. glandulosus leaf powder were monoterpenes. The major non-monoterpenic constituent was an oxygenated sesquiterpene, β caryophyllene oxide. The chemical analysis of H. acida ash showed that calcium (5800 mg/kg) and phosphorus (2782 mg/kg) recorded higher content than the other minerals. Plectranthus glandulosus leaf powder, H. acida wood ash and their binary combinations significantly induced mortality of S. zeamais adult (P < 0.0001). The higher mortality rate was achieved by the highest content within 14 days of exposure. The combinations of P. glandulosus leaf powder with H. acida at different proportions produced different interactions. The mixture of 75% P. glandulosus and 25% H. acida produced synergistic effect, whereas the mixture of 50:50 had antagonistic effect in weevil mortality. The three combinations of H. acida and P. glandulosus significantly reduced the production of the progeny compared to the control. From the application of 5 g/kg (lowest content), the number of emerging adults was highly reduced. The combination 25PG75HA revealed to be more effective than the two other against F1 production. The grain damage and population growth were significantly reduced. In general, the non-infested maize grain had a good germination rate than the infested ones. The treatment did not have negative effect on seed germination. Conclusions From our results, the two powders and their binary combinations could be used to reduce grain infestation by insect while taking into account the proportions of insecticidal powders implied in the combination