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

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

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Prognostic impact of diabetes and prediabetes on survival outcomes in patients with chronic heart failure: A post-hoc analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial

826BACKGROUND: The independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre-DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre-DM on survival outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. METHODS AND RESULTS: We assessed the risk of all-cause death and the composite of all-cause death or cardiovascular hospitalization over a median follow-up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI-HF trial, who were stratified by presence of DM (n=2852), pre-DM (n=2013), and non-DM (n=2070) at baseline. Compared with non-DM patients, those with DM had remarkably higher incidence rates of all-cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non-DM patients and those with pre-DM. Cox regression analysis showed that DM, but not pre-DM, was associated with an increased risk of all-cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28-1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13-1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all-cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02-1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01-1.29, respectively). CONCLUSIONS: Presence of DM was independently associated with poor long-term survival outcomes in patients with chronic heart failure.openopenDauriz, Marco; Targher, Giovanni; Temporelli, Pier Luigi; Lucci, Donata; Gonzini, Lucio; Nicolosi, Gian Luigi; Marchioli, Roberto; Tognoni, Gianni; Latini, Roberto; Cosmi, Franco; Tavazzi, Luigi; Maggioni, Aldo Pietro*; Moccetti, T.; Rossi, M.G.; Pasotti, E.; Vaghi, F.; Roncarolo, P.; Zunino, M.T.; Matta, F.; Actis Perinetto, E.; Gaita, F.; Azzaro, G.; Zanetta, M.; Paino, A.M.; Parravicini, U.; Vegis, D.; Conte, R.; Ferraro, P.; De Bernardi, A.; Morelloni, S.; Fagnani, M.; Greco Lucchina, P.; Montagna, L.; Bellone, E.; Sappè, D.; Ferraro, F.; Delucchi, M.; Reynaud, S.G.; Dore, M.; La Brocca, A.; Massobrio, N.; Bo, L.; Trinchero, R.; Imazio, M.; Brocchi, G.; Nejrotti, A.; Rissone, L.; Gabasio, S.; Zocchi, C.; Randazzo, S.; Crenna, A.; Giannuzzi, P.; Bonanomi, E.; Mezzani, A.; De Marchi, M.; Begliuomini, G.; Gianonatti, C.A.; Gavazzi, A.; Grosu, A.; Dei Cas, L.; Nodari, S.; Garyfallidis, P.; Bertoletti, A.; Bonifazi, C.; Arisi, S.; Mascaro, F.; Fraccarollo, M.; Dell'Orto, S.; Sfolcini, M.; Bortolini, F.; Raccagni, D.; Turelli, A.; Santarone, M.; Miglierina, E.; Sormani, L.; Jemoli, R.; Tettamanti, F.; Pirelli, S.; Bianchi, C.; Verde, S.; Mariani, M.; Ziacchi, V.; Ferrazza, A.; Russo, A.; Bortolotti, M.; Pasini, G.F.; Volpi, A.; Jones, K.N.; Cuzzucrea, D.; Gullace, G.; Carbone, C.; Granata, A.; De Servi, S.; Del Rosso, G.; Inserra, C.; Renaldini, E.; Zappa, C.; Moretti, M.; Zanini, R.; Ferrari, M.; Moroni, E.; Cei, A.; Lissi, C.; Dovico, E.; Fiorentini, C.; Palermo, P.; Brusoni, B.; Negrini, M.; Heyman, J.; Danzi, G.B.; Finzi, A.; Frigerio, M.; Turazza, F.; Beretta, L.; Sachero, A.; Casazza, F.; Squadroni, L.; Lombardi, F.; Marano, L.; Margonato, A.; Fragasso, G.; Febo, O.C.; Aiolfi, E.; Olmetti, F.; Grieco, A.; Antonazzo, V.; Specchia, G.; Mortara, A.; Robustelli, F.; Songini, M.G.; Schweiger, C.; Frisinghelli, A.; Palvarini, M.; Campana, C.; Scelsi, L.; Ajmone Marsan, N.; Cobelli, F.; Gualco, A.; Opasich, C.; De Feo, S.; Mazzucco, R.; Iannone, M.A.; Diaco, T.; Zaniboni, D.; Milanesi, G.; Nassiacos, D.; Meloni, S.; Giani, P.; Nicoli, T.; Malinverni, C.; Gusmini, A.; Pozzoni, L.; Bisiani, G.; Margaroli, P.; Schizzarotto, A.; Daverio, A.; Occhi, G.; Partesana, N.; Bandini, P.; Rosella, M.G.; Giustiniani, S.; Cucchi, G.; Pedretti, R.; Raimondo, R.; Vaninetti, R.; Fedele, A.; Ghezzi, I.; Rezzonico, E.; Salerno Uriarte, J.A.; Morandi, F.; Salvucci, F.; Valenti, C.; Graziano, G.; Romanò, M.; Cimminiello, C.; Mangone, I.; Lombardo, M.; Quorso, P.; Marinoni, G.; Breghi, M.; Erckert, M.; Dienstl, A.; Mirante Marini, G.; Stefenelli, C.; Cioffi, G.; Buczkowska, E.; Bonanome, A.; Bazzanini, F.; Parissenti, L.; Serafini, C.; Catania, G.; Tarantini, L.; Rigatelli, G.; Boni, S.; Pasini, A.; Masini, E.; Zampiero, A.A.; Zanchetta, M.; Franceschetto, L.; Delise, P.; Marcon, C.; Sacchetta, A.; Borgese, L.; Artusi, L.; Casolino, P.; Corbara, F.; Banzato, A.; Barbiero, M.; Aldegheri, M.P.; Bazzucco, R.; Crivellenti, G.; Raviele, A.; Zanella, C.; Pascotto, P.; Sarto, P.; Milan, S.; Barbieri, E.; Girardi, P.; Dalla Villa, W.; Dalle Mule, J.; Di Sipio, M.L.; Cazzin, R.; Milan, D.; Zonzin, P.; Carraro, M.; Rossi, R.; Carbonieri, E.; Rossi, I.; Stritoni, P.; Meneghetti, P.; Risica, G.; Tenderini, P.L.; Vassanelli, C.; Zanolla, L.; Perini, G.; Brighetti, G.; Chiozza, R.; Giuliano, G.; Baldin, M.G.; Gortan, R.; Cesanelli, R.; Nicolosi, G.L.; Piazza, R.; Mos, L.; Vriz, O.; Pavan, D.; Pascottini, G.; Alberti, E.; Werren, M.; Solinas, L.; Sinagra, G.; Longaro, F.; Fioretti, P.; Albanese, M.C.; Miani, D.; Gianrossi, R.; Pende, A.; Rubartelli, P.; Magaia, O.; Domenicucci, S.; Caruso, D.; Faraguti, A.S.; Magliani, L.; Miccoli, F.; Guglielmino, G.; Bertoli, D.; Cantarelli, A.; Orlandi, S.; Vallebona, A.; Pozzati, A.; Brega, G.; Pancaldi, L.G.; Vandelli, R.; Urbinati, S.; Poci, M.G.; Zoli, M.; Costa, G.M.; Guiducci, U.; Zobbi, G.; Tartagni, F.; Tisselli, A.; Gentili, A.; Pieri, P.; Cagnetta, E.; Bendinelli, S.; Barbieri, A.; Conti, R.; Ferrari, R.; Merlini, F.; Fucili, A.; Moruzzi, P.; Buia, E.; Galvani, M.; Ferrini, D.; Baggioni, G.; Yiannacopulu, P.; Canè, G.; Bonfiglioli, A.; Zandomeneghi, R.; Brugioni, L.; Giannini, A.; Di Ruvo, R.; Giuliani, M.; Rusconi, L.; Del Corso, P.; Piovaccari, G.; Bologna, F.; Venturi, P.; Melandri, F.; Bagni, E.; Bolognese, L.; Perticucci, R.; Zuppiroli, A.; Nannini, M.; Consoli, N.; Petrone, P.; Pipitò, C.; Colombi, L.; Bernardi, D.; Mariani, P.R.; Testa, R.; Mazzinghi, F.; Cosmi, F.; Cosmi, D.; Zipoli, A.; Cecchi, A.; Castelli, G.; Ciaccheri, M.; Mori, F.; Pieri, F.; Valoti, P.; Chiarantini, D.; Santoro, G.M.; Minneci, C.; Marchi, F.; Milli, M.; Zambaldi, G.; Zipoli, A.; Brandinelli Geri, A.A.; Cipriani, M.; Alessandri, M.; Severi, S.; Stefanelli, S.; Comella, A.; Poddighe, R.; Digiorgio, A.; Carluccio, M.; Berti, S.; Rizza, A.; Bonatti, V.; Molendi, V.; Brancato, A.; D'Aprile, N.; Giappichini, G.; Del Vecchio, S.; Mantini, G.; De Tommasi, F.; Meucci, G.; Cordoni, M.; Bechi, S.; Barsotti, L.; Baldini, P.; Romei, M.; Scopelliti, G.; Lauri, G.; Pestelli, F.; Furiozzi, F.; Cocchieri, M.; Severini, D.; Patriarchi, F.; Chiocchi, P.; Buccolieri, M.; Martinelli, S.; Wee, A.; Angelici, F.; Bernardinangeli, M.; Proietti, G.; Biscottini, B.; Panciarola, R.; Marinacci, L.; Perna, G.P.; Gabrielli, D.; Moraca, A.; Moretti, L.; Partemi, L.; Gregori, G.; Amici, R.; Patteri, G.; Capone, P.; Savini, E.; Morgagni, G.L.; Paccaloni, L.; Pezzuoli, F.; Carincola, S.; Papi, S.; De Crescentini, S.; Gerardi, P.; Midi, P.; Gallenzi, E.; Pajes, G.; Mancone, C.; Di Spirito, V.; Di Gennaro, M.; Calcagno, S.; Toscano, S.; Antonicoli, S.; Carta, F.; Giorgi, G.; Comito, F.; Daniele, E.; Ciarla, O.; Gelfo, P.G.; Acquaviva, A.; Testa, D.; Testa, G.; Pagliaro, F.A.; Russo, F.; Vetta, F.; Marchese, I.; Di Sciascio, G.; D'Ambrosio, A.; Leggio, F.; Del Sindaco, D.; Lacchè, A.; Avallone, A.; Risa, M.P.; Azzolini, P.; Baldo, E.; Giovannini, E.; Pulignano, G.; Tondo, C.; Picchio, E.; Biffani, E.; Tanzi, P.; Pozzar, F.; Farnetti, F.; Azzarito, M.; Santini, M.; Varveri, A.; Ferraiuolo, G.; Valtorta, C.; Gaspardone, A.; Barbato, G.; Ceci, V.; Aspromonte, N.; Bellocci, F.; Colizzi, C.; Fedele, F.; Perez, F.I.; Galati, A.; Rossetti, A.; Mainella, A.; Ciuffetta, D.; Matteucci, C.; Busi, G.; De Angelis, A.; Farina, G.; Granatelli, A.; Leone, F.; Frasca, F.; Pajes, G.; Di Giovambattista, R.; Castellani, G.; Massaro, G.; Mastrogiuseppe, G.; Vacri, A.; De Sanctis, F.; Cioli, M.; Di Luzio, S.; Napoletano, C.; Piccioni, L.L.; De Simone, G.; Ottaviano, A.; Mazza, V.; Spedaliere, C.; Staniscia, D.; Calgione, E.; De Marco, G.; Chiacchio, T.; Di Napoli, T.; Romanzi, S.; Salvatore, G.; Golino, P.; Palermo, A.; Mascia, F.; Vetrano, A.; Vinciguerra, A.; Caliendo, L.; Longobardi, R.; De Caro, G.; Di Nola, R.; Piemonte, F.; Prinzi, D.; De Rosa, P.; De Rosa, V.; Riello, F.; Capuano, V.; Vecchio, G.; Landi, M.; Amato, S.; Garofalo, M.; Caruso, D.; D'Avino, M.; Sensale, P.; Maiolica, O.; Santoro, R.; Caso, P.; Miceli, D.; Maurea, N.; Bianchi, U.; Crispo, C.; Chiariello, M.; Perrone Filardi, P.; Russo, L.; Capuano, N.; Ungaro, G.; Vergara, G.; Scafuro, F.; D'Angelo, G.; Campaniello, C.; Bottiglieri, P.; Volpe, A.; Battista, R.; De Risi, L.; Cardillo, G.; Sibilio, G.; Marino, A.P.; Silvestri, F.; Predotti, P.; Iervoglini, A.; Stefanelli, S.; De Matteis, C.; Sarnicola, P.; Matarazzo, M.M.; Baldi, S.; Iuliano, V.; Astarita, C.; Cuccaro, P.; Liguori, A.; Liguori, G.; Gregorio, G.; Petraglia, L.; Antonelli, G.; Amodio, G.; De Luca, I.; Traversa, D.; Franchini, G.; Lenti, M.L.; Cavallari, D.; D'Agostino, C.; Scalera, G.; Altamura, C.M.; Russo, M.; Mascolo, A.R.; Pettinati, G.; Ciricugno, S.A.; Scrutinio, D.; Passantino, A.; Mastrangelo, D.; Di Masi, A.; De Carne, R.; Cannone, M.; Dibiase, F.; Pensato, M.; Loliva, F.; Trapani, F.; Panettieri, I.; Leone, L.; Di Biase, M.; Carrone, M.; Gallone, V.; Cocco, F.; Costantini, M.; Tritto, C.; Cavalieri, F.; Stella, L.; Magliari, F.; Callerame, M.; De Giorgi, A.; Pellegrino, L.; Correra, M.; Portulano, V.; Nisi, G.L.; Grassi, G.; Cristallo, E.; De Laura, D.; Salerno, C.; Fanelli, R.; Villella, M.; Pede, S.; Renna, A.; De Lorenzi, E.; Urso, L.; Lenti, V.; Peluso, A.; Baldi, N.; Polimeni, G.; Galati, A.; Palma, P.; Lauletta, R.; Tagliamonte, E.; Cirillo, T.; Silvestri, B.; Centonze, G.; D'Alessandro, B.; Truncellito, L.; Mecca, D.; Petruzzi, M.A.; Coviello, R.O.M.; Lopizzo, A.; Chiaffitelli, M.; Barbuzzi, S.; Gubelli, S.; Germinario, G.; Cosentino, N.; Mingrone, A.; Vico, R.; Borrello, G.; Mazza, M.L.; Cimino, R.; Galasso, D.; Cassadonte, F.; Talarico, U.; Perticone, F.; Cassano, S.; Catapano, F.; Calemme, S.; Feraco, E.; Cloro, C.; Misuraca, G.; Caporale, R.; Vigna, L.; Spagnuolo, V.; De Rosa, F.; Spadafora, G.; Zampaglione, G.; Russo, R.; Schipani, F.A.; Ferragina, A.F.; Stranieri, D.; Musca, G.; Carpino, C.; Bencardino, P.; Raimondo, F.; Musacchio, D.; Pulitanò, G.; Ruggeri, A.; Provenzano, A.; Salituri, S.; Musolino, M.; Calandruccio, S.; Marrari, A.; Tripodi, E.; Scali, R.; Anastasio, L.; Arone, A.; Aragona, P.; Donnangelo, L.; Comito, M.G.A.; Bilotta, F.; Vaccaro, I.; Rametta, R.; Ventura, V.; Bonvegna, A.; Alì, A.; Cinnirella, C.; Raineri, M.; Pompeo, F.; Cascio Ingurgio, N.; Carini, V.; Coco, R.; Giunta, G.; Leonardi, G.; Randazzo, V.; Di Blasi, V.; Tamburino, C.; Russo, G.; Mangiameli, S.; Cardillo, R.; Castelli, D.; Inserra, V.; Arena, A.; Gulizia, M.M.; Raciti, S.; Rapisarda, G.; Romano, R.; Prestifilippo, P.; Braschi, G.B.; Ledda, G.; Terrazzino, R.; De Caro, M.; Scilabra, G.; Graffagnino, B.; Grassi, R.; Di Tano, G.; Scimone, G.F.; Vasquez, L.; Coppolino, C.; Casale, A.; Castelli, M.; D'Urso, G.; D'Antonio, E.; Lo Presti, L.; Badalamenti, E.; Conti, P.; Sanfilippo, N.; Cirrincione, V.; Cinà, M.T.; Cusimano, G.; Taormina, A.; Giuliano, P.; Bajardi, A.; Mandalà, V.; Canonico, A.; Geraci, G.; Sabella, F.P.; Enia, F.; Floresta, A.M.; Lo Cascio, I.; Gumina, D.; Cavallaro, A.; Piccione, G.; Ferrante, R.; Blandino, M.; Iudicello, M.S.; Mossuti, E.; Romano, G.; Lombardo, L.; Monastra, P.; Di Vincenzo, D.; Porcu, M.; Orrù, P.; Muscas, F.; Giardina, G.; Corda, M.; Locci, G.; Podda, A.; Ledda, M.; Siddi, P.; Lai, C.; Pili, G.; Mercuro, G.; Mureddu, G.; Ganau, A.; Meloni, G.; Poddighe, G.; Sanna, G.; Barlera, Simona; Franzosi, Maria Grazia; Porcu, Maurizio; Yusuf, Salim; Camerini, Fulvio; Cohn, Jay N.; Decarli, Adriano; Pitt, Bertram; Sleight, Peter; Poole-Wilson, Philip A.; Geraci, Enrico; Scherillo, Marino; Fabbri, Gianna; Bartolomei, Barbara; Bertoli, Daniele; Cobelli, Franco; Fresco, Claudio; Ledda, Antonietta; Levantesi, Giacomo; Opasich, Cristina; Rusconi, Franco; Sinagra, Gianfranco; Turazza, Fabio; Volpi, Alberto; Ceseri, Martina; Alongi, Gianluca; Atzori, Antonio; Bambi, Filippo; Bastarolo, Desiree; Bianchini, Francesca; Cangioli, Iacopo; Canu, Vittoriana; Caporusso, Concetta; Cenni, Gabriele; Cintelli, Laura; Cocchio, Michele; Confente, Alessia; Fenicia, Eva; Friso, Giorgio; Gianfriddo, Marco; Grilli, Gianluca; Lazzaro, Beatrice; Lonardo, Giuseppe; Luise, Alessia; Nota, Rachele; Orlando, Mariaelena; Petrolo, Rosaria; Pierattini, Chiara; Pierota, Valeria; Provenzani, Alessandro; Quartuccio, Velia; Ragno, Anna; Serio, Chiara; Spolaor, Alvise; Tafi, Arianna; Tellaroli, Elisa; Ghio, Stefano; Ghizzardi, Elisa; Masson, Serge; Crociati, Lella; La Rovere, Maria Teresa; Corrà, Ugo; Di Giulio, Paola; Finzi, Andrea; Gorini, Marco; Milani, Valentina; Orsini, Giampietro; Bianchini, Elisa; Cabiddu, Silvia; Cangioli, Ilaria; Cipressa, Laura; Cipressa, Maria Lucia; Di Bitetto, Giuseppina; Ferri, Barbara; Galbiati, Luisa; Lorimer, Andrea; Pera, Carla; Priami, Paola; Vasamì, AntonellaDauriz, Marco; Targher, Giovanni; Temporelli, Pier Luigi; Lucci, Donata; Gonzini, Lucio; Nicolosi, Gian Luigi; Marchioli, Roberto; Tognoni, Gianni; Latini, Roberto; Cosmi, Franco; Tavazzi, Luigi; Maggioni, Aldo Pietro; Moccetti, T.; Rossi, M. G.; Pasotti, E.; Vaghi, F.; Roncarolo, P.; Zunino, M. T.; Matta, F.; Actis Perinetto, E.; Gaita, F.; Azzaro, G.; Zanetta, M.; Paino, A. M.; Parravicini, U.; Vegis, D.; Conte, R.; Ferraro, P.; De Bernardi, A.; Morelloni, S.; Fagnani, M.; Greco Lucchina, P.; Montagna, L.; Bellone, E.; Sappè, D.; Ferraro, F.; Delucchi, M.; Reynaud, S. G.; Dore, M.; La Brocca, A.; Massobrio, N.; Bo, L.; Trinchero, R.; Imazio, M.; Brocchi, G.; Nejrotti, A.; Rissone, L.; Gabasio, S.; Zocchi, C.; Randazzo, S.; Crenna, A.; Giannuzzi, P.; Bonanomi, E.; Mezzani, A.; De Marchi, M.; Begliuomini, G.; Gianonatti, C. A.; Gavazzi, A.; Grosu, A.; Dei Cas, L.; Nodari, S.; Garyfallidis, P.; Bertoletti, A.; Bonifazi, C.; Arisi, S.; Mascaro, F.; Fraccarollo, M.; Dell'Orto, S.; Sfolcini, M.; Bortolini, F.; Raccagni, D.; Turelli, A.; Santarone, M.; Miglierina, E.; Sormani, L.; Jemoli, R.; Tettamanti, F.; Pirelli, S.; Bianchi, C.; Verde, S.; Mariani, M.; Ziacchi, V.; Ferrazza, A.; Russo, A.; Bortolotti, M.; Pasini, G. F.; Volpi, A.; Jones, K. N.; Cuzzucrea, D.; Gullace, G.; Carbone, C.; Granata, A.; De Servi, S.; Del Rosso, G.; Inserra, C.; Renaldini, E.; Zappa, C.; Moretti, M.; Zanini, R.; Ferrari, M.; Moroni, E.; Cei, A.; Lissi, C.; Dovico, E.; Fiorentini, C.; Palermo, P.; Brusoni, B.; Negrini, M.; Heyman, J.; Danzi, G. B.; Finzi, A.; Frigerio, M.; Turazza, F.; Beretta, L.; Sachero, A.; Casazza, F.; Squadroni, L.; Lombardi, F.; Marano, L.; Margonato, A.; Fragasso, G.; Febo, O. C.; Aiolfi, E.; Olmetti, F.; Grieco, A.; Antonazzo, V.; Specchia, G.; Mortara, A.; Robustelli, F.; Songini, M. G.; Schweiger, C.; Frisinghelli, A.; Palvarini, M.; Campana, C.; Scelsi, L.; Ajmone Marsan, N.; Cobelli, F.; Gualco, A.; Opasich, C.; De Feo, S.; Mazzucco, R.; Iannone, M. A.; Diaco, T.; Zaniboni, D.; Milanesi, G.; Nassiacos, D.; Meloni, S.; Giani, P.; Nicoli, T.; Malinverni, C.; Gusmini, A.; Pozzoni, L.; Bisiani, G.; Margaroli, P.; Schizzarotto, A.; Daverio, A.; Occhi, G.; Partesana, N.; Bandini, P.; Rosella, M. G.; Giustiniani, S.; Cucchi, G.; Pedretti, R.; Raimondo, R.; Vaninetti, R.; Fedele, A.; Ghezzi, I.; Rezzonico, E.; Salerno Uriarte, J. A.; Morandi, F.; Salvucci, F.; Valenti, C.; Graziano, G.; Romanò, M.; Cimminiello, C.; Mangone, I.; Lombardo, M.; Quorso, P.; Marinoni, G.; Breghi, M.; Erckert, M.; Dienstl, A.; Mirante Marini, G.; Stefenelli, C.; Cioffi, G.; Buczkowska, E.; Bonanome, A.; Bazzanini, F.; Parissenti, L.; Serafini, C.; Catania, G.; Tarantini, L.; Rigatelli, G.; Boni, S.; Pasini, A.; Masini, E.; Zampiero, A. A.; Zanchetta, M.; Franceschetto, L.; Delise, P.; Marcon, C.; Sacchetta, A.; Borgese, L.; Artusi, L.; Casolino, P.; Corbara, F.; Banzato, A.; Barbiero, M.; Aldegheri, M. P.; Bazzucco, R.; Crivellenti, G.; Raviele, A.; Zanella, C.; Pascotto, P.; Sarto, P.; Milan, S.; Barbieri, E.; Girardi, P.; Dalla Villa, W.; Dalle Mule, J.; Di Sipio, M. L.; Cazzin, R.; Milan, D.; Zonzin, P.; Carraro, M.; Rossi, R.; Carbonieri, E.; Rossi, I.; Stritoni, P.; Meneghetti, P.; Risica, G.; Tenderini, P. L.; Vassanelli, C.; Zanolla, L.; Perini, G.; Brighetti, G.; Chiozza, R.; Giuliano, G.; Baldin, M. G.; Gortan, R.; Cesanelli, R.; Nicolosi, G. L.; Piazza, R.; Mos, L.; Vriz, O.; Pavan, D.; Pascottini, G.; Alberti, E.; Werren, M.; Solinas, L.; Sinagra, G.; Longaro, F.; Fioretti, P.; Albanese, M. C.; Miani, D.; Gianrossi, R.; Pende, A.; Rubartelli, P.; Magaia, O.; Domenicucci, S.; Caruso, D.; Faraguti, A. S.; Magliani, L.; Miccoli, F.; Guglielmino, G.; Bertoli, D.; Cantarelli, A.; Orlandi, S.; Vallebona, A.; Pozzati, A.; Brega, G.; Pancaldi, L. G.; Vandelli, R.; Urbinati, S.; Poci, M. G.; Zoli, M.; Costa, G. M.; Guiducci, U.; Zobbi, G.; Tartagni, F.; Tisselli, A.; Gentili, A.; Pieri, P.; Cagnetta, E.; Bendinelli, S.; Barbieri, A.; Conti, R.; Ferrari, R.; Merlini, F.; Fucili, A.; Moruzzi, P.; Buia, E.; Galvani, M.; Ferrini, D.; Baggioni, G.; Yiannacopulu, P.; Canè, G.; Bonfiglioli, A.; Zandomeneghi, R.; Brugioni, L.; Giannini, A.; Di Ruvo, R.; Giuliani, M.; Rusconi, L.; Del Corso, P.; Piovaccari, G.; Bologna, F.; Venturi, P.; Melandri, F.; Bagni, E.; Bolognese, L.; Perticucci, R.; Zuppiroli, A.; Nannini, M.; Consoli, N.; Petrone, P.; Pipitò, C.; Colombi, L.; Bernardi, D.; Mariani, P. R.; Testa, R.; Mazzinghi, F.; Cosmi, F.; Cosmi, D.; Zipoli, A.; Cecchi, A.; Castelli, G.; Ciaccheri, M.; Mori, F.; Pieri, F.; Valoti, P.; Chiarantini, D.; Santoro, G. M.; Minneci, C.; Marchi, F.; Milli, M.; Zambaldi, G.; Zipoli, A.; Brandinelli Geri, A. A.; Cipriani, M.; Alessandri, M.; Severi, S.; Stefanelli, S.; Comella, A.; Poddighe, R.; Digiorgio, A.; Carluccio, M.; Berti, S.; Rizza, A.; Bonatti, V.; Molendi, V.; Brancato, A.; D'Aprile, N.; Giappichini, G.; Del Vecchio, S.; Mantini, G.; De Tommasi, F.; Meucci, G.; Cordoni, M.; Bechi, S.; Barsotti, L.; Baldini, P.; Romei, M.; Scopelliti, G.; Lauri, G.; Pestelli, F.; Furiozzi, F.; Cocchieri, M.; Severini, D.; Patriarchi, F.; Chiocchi, P.; Buccolieri, M.; Martinelli, S.; Wee, A.; Angelici, F.; Bernardinangeli, M.; Proietti, G.; Biscottini, B.; Panciarola, R.; Marinacci, L.; Perna, G. P.; Gabrielli, D.; Moraca, A.; Moretti, L.; Partemi, L.; Gregori, G.; Amici, R.; Patteri, G.; Capone, P.; Savini, E.; Morgagni, G. L.; Paccaloni, L.; Pezzuoli, F.; Carincola, S.; Papi, S.; De Crescentini, S.; Gerardi, P.; Midi, P.; Gallenzi, E.; Pajes, G.; Mancone, C.; Di Spirito, V.; Di Gennaro, M.; Calcagno, S.; Toscano, S.; Antonicoli, S.; Carta, F.; Giorgi, G.; Comito, F.; Daniele, E.; Ciarla, O.; Gelfo, P. G.; Acquaviva, A.; Testa, D.; Testa, G.; Pagliaro, F. A.; Russo, F.; Vetta, F.; Marchese, I.; Di Sciascio, G.; D'Ambrosio, A.; Leggio, F.; Del Sindaco, D.; Lacchè, A.; Avallone, A.; Risa, M. P.; Azzolini, P.; Baldo, E.; Giovannini, E.; Pulignano, G.; Tondo, C.; Picchio, E.; Biffani, E.; Tanzi, P.; Pozzar, F.; Farnetti, F.; Azzarito, M.; Santini, M.; Varveri, A.; Ferraiuolo, G.; Valtorta, C.; Gaspardone, A.; Barbato, G.; Ceci, V.; Aspromonte, N.; Bellocci, F.; Colizzi, C.; Fedele, F.; Perez, F. I.; Galati, A.; Rossetti, A.; Mainella, A.; Ciuffetta, D.; Matteucci, C.; Busi, G.; De Angelis, A.; Farina, G.; Granatelli, A.; Leone, F.; Frasca, F.; Pajes, G.; Di Giovambattista, R.; Castellani, G.; Massaro, G.; Mastrogiuseppe, G.; Vacri, A.; De Sanctis, F.; Cioli, M.; Di Luzio, S.; Napoletano, C.; Piccioni, L. L.; De Simone, G.; Ottaviano, A.; Mazza, V.; Spedaliere, C.; Staniscia, D.; Calgione, E.; De Marco, G.; Chiacchio, T.; Di Napoli, T.; Romanzi, S.; Salvatore, G.; Golino, P.; Palermo, A.; Mascia, F.; Vetrano, A.; Vinciguerra, A.; Caliendo, L.; Longobardi, R.; De Caro, G.; Di Nola, R.; Piemonte, F.; Prinzi, D.; De Rosa, P.; De Rosa, V.; Riello, F.; Capuano, V.; Vecchio, G.; Landi, M.; Amato, S.; Garofalo, M.; Caruso, D.; D'Avino, M.; Sensale, P.; Maiolica, O.; Santoro, R.; Caso, P.; Miceli, D.; Maurea, N.; Bianchi, U.; Crispo, C.; Chiariello, M.; Perrone Filardi, P.; Russo, L.; Capuano, N.; Ungaro, G.; Vergara, G.; Scafuro, F.; D'Angelo, G.; Campaniello, C.; Bottiglieri, P.; Volpe, A.; Battista, R.; De Risi, L.; Cardillo, G.; Sibilio, G.; Marino, A. P.; Silvestri, F.; Predotti, P.; Iervoglini, A.; Stefanelli, S.; De Matteis, C.; Sarnicola, P.; Matarazzo, M. M.; Baldi, S.; Iuliano, V.; Astarita, C.; Cuccaro, P.; Liguori, A.; Liguori, G.; Gregorio, G.; Petraglia, L.; Antonelli, G.; Amodio, G.; De Luca, I.; Traversa, D.; Franchini, G.; Lenti, M. L.; Cavallari, D.; D'Agostino, C.; Scalera, G.; Altamura, C. M.; Russo, M.; Mascolo, A. R.; Pettinati, G.; Ciricugno, S. A.; Scrutinio, D.; Passantino, A.; Mastrangelo, D.; Di Masi, A.; De Carne, R.; Cannone, M.; Dibiase, F.; Pensato, M.; Loliva, F.; Trapani, F.; Panettieri, I.; Leone, L.; Di Biase, M.; Carrone, M.; Gallone, V.; Cocco, F.; Costantini, M.; Tritto, C.; Cavalieri, F.; Stella, L.; Magliari, F.; Callerame, M.; De Giorgi, A.; Pellegrino, L.; Correra, M.; Portulano, V.; Nisi, G. L.; Grassi, G.; Cristallo, E.; De Laura, D.; Salerno, C.; Fanelli, R.; Villella, M.; Pede, S.; Renna, A.; De Lorenzi, E.; Urso, L.; Lenti, V.; Peluso, A.; Baldi, N.; Polimeni, G.; Galati, A.; Palma, P.; Lauletta, R.; Tagliamonte, E.; Cirillo, T.; Silvestri, B.; Centonze, G.; D

Regular Wine Consumption in Chronic Heart Failure: Impact on Outcomes, Quality of Life, and Circulating Biomarkers

Background-Moderate, regular alcohol consumption is generally associated with a lower risk of cardiovascular events but data in patients with chronic heart failure are scarce. We evaluated the relations between wine consumption, health status, circulating biomarkers, and clinical outcomes in a large Italian population of patients with chronic heart failure enrolled in a multicenter clinical trial. Methods and Results-A brief questionnaire on dietary habits was administered at baseline to 6973 patients enrolled in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) trial. The relations between wine consumption, fatal and nonfatal clinical end points, quality of life, symptoms of depression, and circulating biomarkers of cardiac function and inflammation (in subsets of patients) were evaluated with simple and multivariable-adjusted statistical models. Almost 56% of the patients reported drinking at least 1 glass of wine per day. After adjustment, clinical outcomes were not significantly different in the predefined 4 groups of wine consumption. However, patients with more frequent wine consumption had a significantly better perception of health status (Kansas City Cardiomyopathy Questionnaire score, adjusted P&lt;0.0001), less frequent symptoms of depression (Geriatric Depression Scale, adjusted P=0.01), and lower plasma levels of biomarkers of vascular inflammation (osteoprotegerin and C-terminal proendothelin-1, adjusted P&lt;0.0001, and pentraxin-3, P=0.01) after adjusting for possible confounders. Conclusions-We show for the first time in a large cohort of patients with chronic heart failure that moderate wine consumption is associated with a better perceived and objective health status, lower prevalence of depression, and less vascular inflammation, but does not translate into more favorable clinical 4-year outcomes. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT0033633

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London