National economic and environmental development study: the case of Pakistan

Pakistan is a developing country bracing for significant economic growth and development in the future. In this regards, the country is poised to shift towards an increased reliance upon its indigenous coal reserves to fuel its development in the 2010-2050 time frame. Although this will significantly raise its projected greenhouse gas emissions, the present study has identified numerous measures which can be taken to shift this future development pathway on to a lower carbon and more climate friendly trajectory. The country, however, requires this shift to be supported through the access and transfer of appropriate technologies and finance. The ensuing “additional” financial needs for mitigation for a cleaner development future range from between U$8 billion and U$ 17 billion. These have been identified in this report along with a potential of 18% and 40% reduction of emissions between below “Business As Usual” scenario which is possible with a shift towards cleaner technologies. These clean development investments, however, need to be made in the near future as otherwise the energy future of Pakistan will get locked into the lower cost - higher carbon options. This mitigation costing estimate will, however, need to be refined and focused further as Pakistan identifies not only the specific technologies that it needs for this low carbon shift (through carrying out the “Technology Needs Assessment”) but also the programmatic, sectoral as well as project specific NAMAs (Nationally Appropriate Mitigation Actions) in the near future. Pakistan is also highly vulnerable to the impacts of climate change and faces immense associated challenges in coping with its unavoidable effects and economic implications. This study has highlighted the need to treat adaptation to climate change as a primary development issue for Pakistan. The potential impacts and sectors demanding prioritized adaptation have been identified in this study and the, associated, costs of adaptation have been estimated utilizing three diverse modeling methodologies – using GDP projections, per-capita figures and “flood” disaster modeling. The resulting adaptation cost figures range from between U$6 billion to U$ 14 billion/year that Pakistan would have to spend at an average in the 2010-2050 time frame to cope with the effects of climate change while it will be also left to, unavoidably, bear significant “residual damage” costs induced due to climate change. The top-down adaptation costing analysis applied in this report is aimed at providing a reasonable first approximation that can be refined over time as relevant and reliable local data becomes available especially from research focusing on sector specific adaptation costing. Most significantly the report reinforces the fact that the issue of climate change is, thus, not only an environmental issue challenging the country but an issue which will directly impinge upon the country’s economic, financial and development future as it deals with its extreme vulnerability to climate change. The significant climate costs identified in this study inextricably shows that climate change is an issue which Pakistan can ill afford to ignore in the future. Finally the report has identified the major financing options available for climate change related activities in Pakistan as well as the significant unilateral climate resources, U$ 4.5 billion in 2007-2009 alone, that the country is already committing to climate change without getting any global recognition for its efforts. In future, global financing will need to augment and leverage such national financial commitments. Also, as climate finance becomes increasingly available at the global level, it would be essential to enact appropriate assimilative national capacity in Pakistan to direct this finance towards nationally identified priorities as well as channelize it transparently and efficiently through consolidated financial mechanisms like a National Climate Change Fund which has been proposed through this study.climate change Pakistan

National economic and environmental development study: the case of Pakistan

Pakistan is a developing country bracing for significant economic growth and development in the future. In this regards, the country is poised to shift towards an increased reliance upon its indigenous coal reserves to fuel its development in the 2010-2050 time frame. Although this will significantly raise its projected greenhouse gas emissions, the present study has identified numerous measures which can be taken to shift this future development pathway on to a lower carbon and more climate friendly trajectory. The country, however, requires this shift to be supported through the access and transfer of appropriate technologies and finance. The ensuing “additional” financial needs for mitigation for a cleaner development future range from between U$8 billion and U$ 17 billion. These have been identified in this report along with a potential of 18% and 40% reduction of emissions between below “Business As Usual” scenario which is possible with a shift towards cleaner technologies. These clean development investments, however, need to be made in the near future as otherwise the energy future of Pakistan will get locked into the lower cost - higher carbon options. This mitigation costing estimate will, however, need to be refined and focused further as Pakistan identifies not only the specific technologies that it needs for this low carbon shift (through carrying out the “Technology Needs Assessment”) but also the programmatic, sectoral as well as project specific NAMAs (Nationally Appropriate Mitigation Actions) in the near future. Pakistan is also highly vulnerable to the impacts of climate change and faces immense associated challenges in coping with its unavoidable effects and economic implications. This study has highlighted the need to treat adaptation to climate change as a primary development issue for Pakistan. The potential impacts and sectors demanding prioritized adaptation have been identified in this study and the, associated, costs of adaptation have been estimated utilizing three diverse modeling methodologies – using GDP projections, per-capita figures and “flood” disaster modeling. The resulting adaptation cost figures range from between U$6 billion to U$ 14 billion/year that Pakistan would have to spend at an average in the 2010-2050 time frame to cope with the effects of climate change while it will be also left to, unavoidably, bear significant “residual damage” costs induced due to climate change. The top-down adaptation costing analysis applied in this report is aimed at providing a reasonable first approximation that can be refined over time as relevant and reliable local data becomes available especially from research focusing on sector specific adaptation costing. Most significantly the report reinforces the fact that the issue of climate change is, thus, not only an environmental issue challenging the country but an issue which will directly impinge upon the country’s economic, financial and development future as it deals with its extreme vulnerability to climate change. The significant climate costs identified in this study inextricably shows that climate change is an issue which Pakistan can ill afford to ignore in the future. Finally the report has identified the major financing options available for climate change related activities in Pakistan as well as the significant unilateral climate resources, U$ 4.5 billion in 2007-2009 alone, that the country is already committing to climate change without getting any global recognition for its efforts. In future, global financing will need to augment and leverage such national financial commitments. Also, as climate finance becomes increasingly available at the global level, it would be essential to enact appropriate assimilative national capacity in Pakistan to direct this finance towards nationally identified priorities as well as channelize it transparently and efficiently through consolidated financial mechanisms like a National Climate Change Fund which has been proposed through this study

National economic and environmental development study: the case of Pakistan

Pakistan is a developing country bracing for significant economic growth and development in the future. In this regards, the country is poised to shift towards an increased reliance upon its indigenous coal reserves to fuel its development in the 2010-2050 time frame. Although this will significantly raise its projected greenhouse gas emissions, the present study has identified numerous measures which can be taken to shift this future development pathway on to a lower carbon and more climate friendly trajectory. The country, however, requires this shift to be supported through the access and transfer of appropriate technologies and finance. The ensuing “additional” financial needs for mitigation for a cleaner development future range from between U$8 billion and U$ 17 billion. These have been identified in this report along with a potential of 18% and 40% reduction of emissions between below “Business As Usual” scenario which is possible with a shift towards cleaner technologies. These clean development investments, however, need to be made in the near future as otherwise the energy future of Pakistan will get locked into the lower cost - higher carbon options. This mitigation costing estimate will, however, need to be refined and focused further as Pakistan identifies not only the specific technologies that it needs for this low carbon shift (through carrying out the “Technology Needs Assessment”) but also the programmatic, sectoral as well as project specific NAMAs (Nationally Appropriate Mitigation Actions) in the near future. Pakistan is also highly vulnerable to the impacts of climate change and faces immense associated challenges in coping with its unavoidable effects and economic implications. This study has highlighted the need to treat adaptation to climate change as a primary development issue for Pakistan. The potential impacts and sectors demanding prioritized adaptation have been identified in this study and the, associated, costs of adaptation have been estimated utilizing three diverse modeling methodologies – using GDP projections, per-capita figures and “flood” disaster modeling. The resulting adaptation cost figures range from between U$6 billion to U$ 14 billion/year that Pakistan would have to spend at an average in the 2010-2050 time frame to cope with the effects of climate change while it will be also left to, unavoidably, bear significant “residual damage” costs induced due to climate change. The top-down adaptation costing analysis applied in this report is aimed at providing a reasonable first approximation that can be refined over time as relevant and reliable local data becomes available especially from research focusing on sector specific adaptation costing. Most significantly the report reinforces the fact that the issue of climate change is, thus, not only an environmental issue challenging the country but an issue which will directly impinge upon the country’s economic, financial and development future as it deals with its extreme vulnerability to climate change. The significant climate costs identified in this study inextricably shows that climate change is an issue which Pakistan can ill afford to ignore in the future. Finally the report has identified the major financing options available for climate change related activities in Pakistan as well as the significant unilateral climate resources, U$ 4.5 billion in 2007-2009 alone, that the country is already committing to climate change without getting any global recognition for its efforts. In future, global financing will need to augment and leverage such national financial commitments. Also, as climate finance becomes increasingly available at the global level, it would be essential to enact appropriate assimilative national capacity in Pakistan to direct this finance towards nationally identified priorities as well as channelize it transparently and efficiently through consolidated financial mechanisms like a National Climate Change Fund which has been proposed through this study

Time to endoscopy for acute upper gastrointestinal bleeding: results from a prospective multicentre trainee-led audit

Background: Endoscopy within 24 hours of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24h of admission).Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between Nov-Dec 2017. Analyses were performed to identify factorsassociated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups.Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2h (IQR 12.0- 35.7), comprising median admission to referral and referral to endoscopy times of 8.1h (IQR 3.7- 18.1) and 6.7h (IQR 3.0-23.1) respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0% - 87.5%, p=0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7am-7pm or via the Emergency Department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1d; p= 0.004), but not 30-day mortality (p=0.344).Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Patients with Crohn's disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications' rate

BACKGROUNDRight hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC).AIMTo investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODSThis is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.RESULTSThree hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P < 0.01), had lower American Society of Anesthesiology score (ASA) grade (P < 0.01) and less comorbidity (P < 0.01), but were more likely to be current smokers (P < 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P < 0.01) and frequently underwent ileocecal resection (P < 0.01) with higher rate of de-functioning/primary stoma construction (P < 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P < 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSIONPatients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complication's rate was not different between the two groups