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

Structural Raman Studies of GexS1-x Chalcogenide Glasses

The Raman spectra of binary GexS1-x chalcogenide glasses have been measured for various compositions and discussed in terms of the structural units present. High temperature Raman measurements in GexS1-x glasses have shown that, above the glass transition temperature Tg, irreversible two step crystallizations occur for the compound GeS2 (x=1/3) and the moderately rich in Ge (x=0.35) and S (x=0.30) glasses, but in the case of the strongly enriched in S (x=0.20) glass, a one step reversible crystallization takes place with the material returning to its starting glassy phase upon slow cooling to room temperature. The evolution of the A1c companion Raman band of GeS2 glass in the crystalline phases provides evidence (in support of predictions) that this controversial band is associated with symmetric stretching of S atoms in bridges of edge-sharing Ge-(S1/2)4 tetrahedra. Raman measurements above melting point have indicated the existence of tetrahedral units in the molten phase of these glasses. High pressure Raman measurements in GeS2 have shown that the bond lengths decrease substantially with pressure, while the material remains glassy throughout the pressure range of measurements (up to 10.8 GPa). It appears that all pressure induced effects are reversible after pressure relief