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

Reduced Cancer Incidence in Huntington's Disease: Analysis in the Registry Study

Background: People with Huntington’s disease (HD) have been observed to have lower rates of cancers. Objective: To investigate the relationship between age of onset of HD, CAG repeat length, and cancer diagnosis. Methods: Data were obtained from the European Huntington’s disease network REGISTRY study for 6540 subjects. Population cancer incidence was ascertained from the GLOBOCAN database to obtain standardised incidence ratios of cancers in the REGISTRY subjects. Results: 173/6528 HD REGISTRY subjects had had a cancer diagnosis. The age-standardised incidence rate of all cancers in the REGISTRY HD population was 0.26 (CI 0.22–0.30). Individual cancers showed a lower age-standardised incidence rate compared with the control population with prostate and colorectal cancers showing the lowest rates. There was no effect of CAG length on the likelihood of cancer, but a cancer diagnosis within the last year was associated with a greatly increased rate of HD onset (Hazard Ratio 18.94, p < 0.001). Conclusions: Cancer is less common than expected in the HD population, confirming previous reports. However, this does not appear to be related to CAG length in HTT. A recent diagnosis of cancer increases the risk of HD onset at any age, likely due to increased investigation following a cancer diagnosis

Designing dynamic tests to assess rate dependence in large-scale crack bridging

A numerical study is used to design test geometries and loading histories that can probe the mode II bridging effect of through-thickness reinforcement in composite laminates loaded at high strain rates. Rate-dependence in the assumed cohesive law of a cohesive fracture model causes large enough changes to calibrate the law, if tests are properly selected to vary the crack sliding displacement rate

The design of dynamic tests to infer rate dependence in large-scale crack bridging

A numerical investigation is used to design test geometries and loading histories that are suitable for probing the mode II bridging effect of through-thickness reinforcement at high strain rates. The bridging effects are represented by a cohesive law and tests are sought that will determine any rate dependence in its parameters. The End Notched Flexural test is used as reference test, because it allows easy application of time dependent loading and has proven to be an information-rich test in the quasi-static case. Information content in the dynamic case is addressed by focusing on regimes within the full computed solution space where crack growth is approximately steady state, the crack sliding speed is constant, and the crack profile is at least partially linear. These conditions simplify the inverse procedure for identifying model parameters, allowing quick insight into the information content of experiments. The estimates of information content are conservative, in that analysis of the total solution regime will necessarily contain more information than analysis of the regimes of simple behavior alone. Numerical analyses are performed to verify if hypothetical rate-dependence in the cohesive law causes strong and measurable changes in the regimes of simple behavior when the tests are properly selected to vary the crack sliding speed