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

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Effect of Salvadora persica (Miswak) leaves and stem aqueous extracts on ovarian folliculogenesis and uterine histology in female albino rats

This work was conducted to evaluate the antifertility activities of Salvadora persica (miswak) aqueous leaves and stem extracts  on female albino Wistar rats. Control animals received 0.5 ml of distilled water (Group 1); experimental animals received 0.5 ml of aqueous solution (1:1 w/v) of miswak leaves (Group2) or stem extract (Group 3) for 14 consecutive days. At the end of experiment, animals were weighed and vaginal smears were obtained from control and treated groups. Control and experimental animals were anesthetized then scarified, ovaries and uterus were dissected out, weighed and the number of corpora lutea and surface ovarian follicles were counted. Ovaries and uterus were fixed then processed for paraffin sections and stained with Hematoxylin-eosin. Histological changes in ovaries and uterus were determined. Results showed that administration of miswak leaves or stem aqueous extract is safe and have no side effects or mortalities, and it did not affect body weight of treated animals compared with control. However, administration of miswak leaves or stem aqueous extract significantly decrease (P&lt;0.05) ovarian weight in treated groups. Uterine weight also significantly decreased (P&lt;0.05) after administration of miswak leaves extract compared to control or stem extract groups. Moreover, number of surface ovarian follicles significantly decreased (P&lt;0.05) after exposure to extract of miswak leaves or stem. Number of corpora lutea did not vary between groups. Histological examination revealed that administration of miswak leaves extract caused a significant decrease in the epithelial cell height, myometrial and stromal thickness of uterus compared to stem extract or control group. The present study illustrated the antiovulatory and anti-uterotrophic effects of the aqueous extract of miswak leaves in female rats. This effect may be mediated through direct effect of the extract on the reproductive organs by disruption of ovarian folliculogenesis and inhibiting further development of the recruited ovarian follicles and/or by disruption of the hormonal balance in the hypothalamo-hypophysial ovarian and uterine axis. Miswak stem extract could affect follicular development but it did not affect the uterine structures

Effect of Salvadora persica (Miswak) leaves and stem aqueous extracts on ovarian folliculogenesis and uterine histology in female albino rats

This work was conducted to evaluate the antifertility activities of Salvadora persica (miswak) aqueous leaves and stem extracts  on female albino Wistar rats. Control animals received 0.5 ml of distilled water (Group 1); experimental animals received 0.5 ml of aqueous solution (1:1 w/v) of miswak leaves (Group2) or stem extract (Group 3) for 14 consecutive days. At the end of experiment, animals were weighed and vaginal smears were obtained from control and treated groups. Control and experimental animals were anesthetized then scarified, ovaries and uterus were dissected out, weighed and the number of corpora lutea and surface ovarian follicles were counted. Ovaries and uterus were fixed then processed for paraffin sections and stained with Hematoxylin-eosin. Histological changes in ovaries and uterus were determined. Results showed that administration of miswak leaves or stem aqueous extract is safe and have no side effects or mortalities, and it did not affect body weight of treated animals compared with control. However, administration of miswak leaves or stem aqueous extract significantly decrease (P&lt;0.05) ovarian weight in treated groups. Uterine weight also significantly decreased (P&lt;0.05) after administration of miswak leaves extract compared to control or stem extract groups. Moreover, number of surface ovarian follicles significantly decreased (P&lt;0.05) after exposure to extract of miswak leaves or stem. Number of corpora lutea did not vary between groups. Histological examination revealed that administration of miswak leaves extract caused a significant decrease in the epithelial cell height, myometrial and stromal thickness of uterus compared to stem extract or control group. The present study illustrated the antiovulatory and anti-uterotrophic effects of the aqueous extract of miswak leaves in female rats. This effect may be mediated through direct effect of the extract on the reproductive organs by disruption of ovarian folliculogenesis and inhibiting further development of the recruited ovarian follicles and/or by disruption of the hormonal balance in the hypothalamo-hypophysial ovarian and uterine axis. Miswak stem extract could affect follicular development but it did not affect the uterine structures