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

Sexualities in State Militaries

This is the author accepted manuscript. The final version is available from Palgrave Macmillan via the DOI in this record.The regulation and role of sexuality within state militaries has been a major concern for gender scholars. Militaries remain important national institutions which reproduce and reinforce social norms and hierarchies around gender, race and sexuality and as Paul Higate (2003b: 209) has argued ‘the inscription of heterosexuality into all aspects of culture… is deeply bound up with the… [combat masculine warrior] ethic.’ Moreover the regulation of sexuality within state militaries is not just an issue of equal opportunities for sexual minorities serving within them. Gendered logics shape the politics of war in liberal democratic states and societies because they ‘help to define the objects and subjects of war – who fights, who dies, who or what should be defended, and to what ends’ (Basham 2013: 7). The official regulation and everyday performances of sexuality and sexual identity within state militaries shape, and are shaped by, the need to legitimise state sanctioned violence. [...