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

Colorado geoid computation experiment: overview and summary

The primary objective of the 1-cm geoid experiment in Colorado (USA) is to compare the numerous geoid computation methods used by different groups around the world. This is intended to lay the foundations for tuning computation methods to achieve the sought after 1-cm accuracy, and also evaluate how this accuracy may be robustly assessed. In this experiment, (quasi)geoid models were computed using the same input data provided by the US National Geodetic Survey (NGS), but using different methodologies. The rugged mountainous study area (730 km × 560 km) in Colorado was chosen so as to accentuate any differences between the methodologies, and to take advantage of newly collected GPS/leveling data of the Geoid Slope Validation Survey 2017 (GSVS17) which are now available to be used as an accurate and independent test dataset. Fourteen groups from fourteen countries submitted a gravimetric geoid and a quasigeoid model in a 1′× 1′ grid for the study area, as well as geoid heights, height anomalies, and geopotential values at the 223 GSVS17 marks. This paper concentrates on the quasigeoid model comparison and evaluation, while the geopotential value investigations are presented as a separate paper (Sánchez et al. in J Geodesy 95(3):1. https://doi.org/10.1007/s00190-021-01481-0, 2021). Three comparisons are performed: the area comparison to show the model precision, the comparison with the GSVS17 data to estimate the relative accuracy of the models, and the differential quasigeoid (slope) comparison with GSVS17 to assess the relative accuracy of the height anomalies at different baseline lengths. The results show that the precision of the 1′ × 1′ models over the complete area is about 2 cm, while the accuracy estimates along the GSVS17 profile range from 1.2 cm to 3.4 cm. Considering that the GSVS17 does not pass the roughest terrain, we estimate that the quasigeoid can be computed with an accuracy of ~ 2 cm in Colorado. The slope comparisons show that RMS values of the differences vary from 2 to 8 cm in all baseline lengths. Although the 2-cm precision and 2-cm relative accuracy have been estimated in such a rugged region, the experiment has not reached the 1-cm accuracy goal. At this point, the different accuracy estimates are not a proof of the superiority of one methodology over another because the model precision and accuracy of the GSVS17-derived height anomalies are at a similar level. It appears that the differences are not primarily caused by differences in theory, but that they originate mostly from numerical computations and/or data processing techniques. Consequently, recommendations to improve the model precision toward the 1-cm accuracy are also given in this paper

Unintended but not unanticipated consequences

The Institutions of Politics; Design, Workings, and implications ( do not use, ended 1-1-2020