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

Expression of sex and reproduction related genes in Marsupenaeus japonicus

Expressed sequence tags (ESTs) were identified from reciprocal suppression subtractive hybridization cDNA libraries from Marsupenaeus japonicus (Kuruma shrimp) female and male gonads. The expression profiles of 24 of these ESTs were determined in female and male gonads and developing postlarvae by real-time quantitative reverse transcription-polymerase chain reaction. When expression was determined in gonads, six of the ESTs were expressed in ovaries only, and five of the ESTs were expressed in testes only. When expression was determined in whole individuals during postlarval development, expression of the ESTs was low and inconsistent until stage PL110 (110 days since metamorphosis from mysis stage to the first postlarval stage). At PL110, seven of the ESTs were detected in females only, and seven ESTs were detected in males only. Sex-specific expression at this developmental stage indicates that these ESTs act as important gonadal development markers and may have a role in gametogenesis. © 2010 Springer Science+Business Media, LLC