8 research outputs found
Caesarean section-related blood transfusion: risk factors in a private teaching hospital in Nigeria
- Publication venue
- 'Medip Academy'
- Publication date
- 28/10/2022
- Field of study
Background: Comprehensive emergency obstetric care, which includes the life-saving procedure of blood transfusion, is one of the essential components of effective emergency obstetric care that leads to a reduction in maternal mortality. In this study, blood transfusion risk factors were found in patients who had Caesarean deliveries at our facility.Methods: This was a retrospective study of all pregnant women who had caesarean section at Babcock University Teaching Hospital, Nigeria between 2016 and 2020. Their medical records were retrieved and reviewed using pro-forma. Chi square analysis was used to determine significant association between blood transfusion status and independent variables. Information was extracted from medical records using pro-forma.Results: Of 1568 obstetric admissions, there were 1210 deliveries and 369 (30.5%) caesarean sections. Ninety-five women (25.7%) of those that had caesarean sections were transfused. The incidence of blood transfusion was 13.7%. The preoperative packed cell volume, age and caesarean delivery type were significantly associated with blood transfusion status (p<0.05).Conclusions: Preoperative anemia, age and caesarean delivery type were all associated with blood transfusion status. To maximize hemoglobin levels at delivery and to identify high-risk patients, regular antenatal checkups should be given more importance
Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021
- Author
- Ababneh Hazim S
- Abate Yohannes Habtegiorgis
- Abbafati Cristiana
- Abbasgholizadeh Rouzbeh
- Abbasian Mohammadreza
- Abbastabar Hedayat
- Abd Al Magied Abdallah H A
- Abd ElHafeez Samar
- Abd-Elsalam Sherief
- Abdelkader Atef
- Abdelmasseh Michael
- Abdi Parsa
- Abdollahi Mohammad
- Abdoun Meriem
- Abdullahi Auwal
- Abebe Mesfin
- Abiodun Olumide
- Aboagye Richard Gyan
- Abolhassani Hassan
- Abouzid Mohamed
- Aboye Girma Beressa
- Abreu Lucas Guimarães
- Absalan Abdorrahim
- Abualruz Hasan
- Abubakar Bilyaminu
- Abukhadijah Hana Jihad Jihad
- Addolorato Giovanni
- Adekanmbi Victor
- Adetunji Charles Oluwaseun
- Adetunji Juliana Bunmi
- Adeyeoluwa Temitayo Esther
- Adha Rishan
- Adhikary Ripon Kumar
- Adnani Qorinah Estiningtyas Sakilah
- Adzigbli Leticia Akua
- Afrashteh Fatemeh
- Afzal Muhammad Sohail
- Afzal Saira
- Agbozo Faith
- Agodi Antonella
- Agrawal Anurag
- Agyemang-Duah Williams
- Ahinkorah Bright Opoku
- Ahlstrom Austin J
- Ahmad Aqeel
- Ahmad Firdos
- Ahmad Muayyad M
- Ahmad Sajjad
- Ahmad Shahzaib
- Ahmed Anisuddin
- Ahmed Ayman
- Ahmed Haroon
- Ahmed Safoora
- Ahmed Syed Anees
- Akinosoglou Karolina
- Akkaif Mohammed Ahmed
- Akrami Ashley E
- Akter Ema
- Al Awaidy Salah
- Al Hasan Syed Mahfuz
- Al Mosa Amjad S
- Al Ta'ani Omar
- Al Zaabi Omar Ali Mohammed
- Al-Ajlouni Yazan
- Al-Aly Ziyad
- Al-amer Rasmieh Mustafa
- Al-Gheethi Adel Ali Saeed
- Al-Hanawi Mohammed Khaled
- Al-Ibraheem Akram
- Al-Mekhlafi Hesham M
- Al-Sabah Salman Khalifah
- Al-Tammemi Ala'a B.
- Al-Tawfiq Jaffar A
- Al-Wardat Mohammad Sami
- Al-Worafi Yaser Mohammed
- Al-Zyoud Walid
- Alahdab Fares
- Alajlani Muaaz M
- Alalalmeh Samer O
- Alam Khurshid
- Alam Noore
- Alam Tahiya
- Alam Zufishan
- Alanezi Fahad Mashhour
- Alanzi Turki M
- Albakri Almaza
- Aldhaleei Wafa A
- Aldridge Robert W
- Alemohammad Seyedeh Yasaman
- Alemu Yihun Mulugeta
- Ali Abid
- Ali Amjad
- Ali Iman
- Ali Mohammed Usman
- Ali Rafat
- Ali Syed Shujait Shujait
- Ali Victor Ekoche
- Ali Waad
- Alicandro Gianfranco
- Alif Sheikh Mohammad
- Aljunid Syed Mohamed
- Alla François
- Almazan Joseph Uy
- Alqutaibi Ahmed Yaseen
- Alrawashdeh Ahmad
- Alrousan Sahel Majed
- Alsabri Mohammed A
- Altaany Zaid
- Altirkawi Khalid A
- Aluh Deborah Oyine
- Alvis-Guzman Nelson
- Aly Hany
- Alyahya Mohammad Sharif
- Alzoubi Karem H
- Amani Reza
- Ameyaw Edward Kwabena
- Amin Tarek Tawfik
- Amindarolzarbi Alireza
- Amiri Sohrab
- Amirzade-Iranaq Mohammad Hosein
- Amu Hubert
- Amugsi Dickson A
- Ancuceanu Robert
- Anderlini Deanna
- Anderson David B
- Andrade Pedro Prata
- Andrei Catalina Liliana
- Andrei Tudorel
- Andrews Erick Adrian
- Anil Abhishek
- Anil Sneha
- Anoushiravani Amir
- Antony Catherine M
- Antriyandarti Ernoiz
- Anuoluwa Boluwatife Stephen
- Anvari Saeid
- Anyasodor Anayochukwu Edward
- Appiah Francis
- Aquilano Michele
- Arab Juan Pablo
- Arabloo Jalal
- Arafa Elshaimaa A
- Arafat Mosab
- Aravkin Aleksandr Y
- Ardekani Ali
- Areda Demelash
- Aregawi Brhane Berhe
- Aremu Abdulfatai
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- Arkew Mesay
- Armani Keivan
- Artamonov Anton A
- Arumugam Ashokan
- Asghari-Jafarabadi Mohammad
- Ashbaugh Charlie
- Astell-Burt Thomas
- Athari Seyyed Shamsadin
- Atorkey Prince
- Atout Maha Moh'd Wahbi
- Aujayeb Avinash
- Ausloos Marcel
- Awad Hamzeh
- Awotidebe Adedapo Wasiu
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- Azadnajafabad Sina
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- Badar Muhammad
- Baghdadi Soroush
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- Barqawi Hiba Jawdat
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- Mokdad Ali H
- Molokhia Mariam
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- Mosapour Abbas
- Mosser Jonathan F
- Mossialos Elias
- Motappa Rohith
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- Mrejen Matías
- Mubarik Sumaira
- Mueller Ulrich Otto
- Mulita Francesk
- Munjal Kavita
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- Wickramasinghe Dakshitha Praneeth
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- Wojewodzic Marcin W
- Woldeyes Dawit Habte
- Wolf Axel Walter
- Wolfe Charles D A
- Wu Chenkai
- Wu Dongze
- Wu Felicia
- Wu Jiayuan
- Wu Zenghong
- Wulf Hanson Sarah
- Xiao Hong
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- Yadav Rakesh
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- Yarahmadi Amir
- Yazdani Nia Iman
- Ye Pengpeng
- Yesodharan Renjulal
- Yesuf Subah Abderehim
- Yezli Saber
- Yigzaw Zeamanuel Anteneh
- Yiğit Arzu
- Yiğit Vahit
- Yin Dehui
- Yip Paul
- Yonemoto Naohiro
- You Yuyi
- Younis Mustafa Z
- Yu Chuanhua
- Yu Elaine A
- Yu Yong
- Yuan Chun-Wei
- Yusuf Hadiza
- Zafar Uzma
- Zafari Nima
- Zahid Mondal Hasan
- Zakham Fathiah
- Zaki Nazar
- Zerfu Taddese Alemu
- Zhang Haijun
- Zhang Jingya
- Zhang Liqun
- Zhang Yunquan
- Zhang Zhiqiang
- Zhao Xiu-Ju George
- Zhao Yang
- Zhao Zhongyi
- Zhong Chenwen
- Zhou Bolun
- Zhou Juexiao
- Zhou Shangcheng
- Zhu Bin
- Zhumagaliuly Abzal
- Zielińska Magdalena
- Zoghi Ghazal
- Zumla Alimuddin
- Zyoud Sa'ed H
- Zyoud Samer H
- Publication venue
- Publication date
- 01/01/2024
- Field of study
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
Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
- Author
- Abate Kalkidan Hassen
- Abate Yohannes Habtegiorgis
- Abbafati Cristiana
- Abbasgholizadeh Rouzbeh
- Abbasi Madineh Akram
- Abbasi-Kangevari Mohsen
- Abbasian Mohammadreza
- Abbasifard Mitra
- Abd ElHafeez Samar
- Abd-Elsalam Sherief
- Abdi Parsa
- Abdollahi Mohammad
- Abdoun Meriem
- Abdulah Deldar Morad
- Abdullahi Auwal
- Abebe Mesfin
- Abedi Aidin
- Abedi Armita
- Abegaz Tadesse M
- Abeldaño Zuñiga Roberto Ariel
- Abiodun Olumide
- Abiso Temesgen Lera
- Aboagye Richard Gyan
- Abolhassani Hassan
- Abouzid Mohamed
- Aboye Girma Beressa
- Abreu Lucas Guimarães
- Abu-Gharbieh Eman
- Abu-Zaid Ahmed
- Abualruz Hasan
- Abubakar Bilyaminu
- Abukhadijah Hana Jihad Jihad
- Aburuz Salahdein
- Adane Mesafint Molla
- Addo Isaac Yeboah
- Addolorato Giovanni
- Adedoyin Rufus Adesoji
- Adekanmbi Victor
- Aden Bashir
- Adetunji Juliana Bunmi
- Adeyeoluwa Temitayo Esther
- Adha Rishan
- Adibi Amin
- Adnani Qorinah Estiningtyas Sakilah
- Adzigbli Leticia Akua
- Afolabi Aanuoluwapo Adeyimika
- Afolabi Rotimi Felix
- Afshin Ashkan
- Afyouni Shadi
- Afzal Muhammad Sohail
- Afzal Saira
- Agampodi Suneth Buddhika
- Agbozo Faith
- Aghamiri Shahin
- Agodi Antonella
- Agrawal Anurag
- Agyemang-Duah Williams
- Ahinkorah Bright Opoku
- Ahmad Aqeel
- Ahmad Danish
- Ahmad Firdos
- Ahmad Noah
- Ahmad Shahzaib
- Ahmad Tauseef
- Ahmed Ali
- Ahmed Anisuddin
- Ahmed Ayman
- Ahmed Luai A
- Ahmed Muktar Beshir
- Ahmed Safoora
- Ahmed Syed Anees
- Ajami Marjan
- Akalu Gizachew Taddesse
- Akara Essona Matatom
- Akbarialiabad Hossein
- Akhlaghi Shiva
- Akinosoglou Karolina
- Akinyemiju Tomi
- Akkaif Mohammed Ahmed
- Akkala Sreelatha
- Akombi-Inyang Blessing
- Al Awaidy Salah
- Al Hasan Syed Mahfuz
- AL-Ahdal Tareq Mohammed Ali
- Al-Aly Ziyad
- Al-Fatly Bassam
- Al-Gheethi Adel Ali Saeed
- Al-Habbal Khairat
- Al-Marwani Sabah
- Al-Mekhlafi Hesham M
- Al-Raddadi Rajaa M
- Al-Rifai Rami Hani
- Al-Sabah Salman Khalifah
- Al-Tawfiq Jaffar A
- Al-Wardat Mohammad Sami
- Al-Worafi Yaser Mohammed
- Al-Zyoud Walid
- Alahdab Fares
- Alalalmeh Samer O
- Alalwan Tariq A
- Alam Khurshid
- Alam Nazmul
- Alanezi Fahad Mashhour
- Alanzi Turki M
- Albakri Almaza
- AlBataineh Mohammad T
- Aldhaleei Wafa A
- Aldridge Robert W
- Alemayohu Mulubirhan Assefa
- Alemu Yihun Mulugeta
- Alhabib Khalid F
- Alhassan Robert Kaba
- Ali Abid
- Ali Amjad
- Ali Beriwan Abdulqadir
- Ali Iman
- Ali Liaqat
- Ali Mohammed Usman
- Ali Rafat
- Ali Syed Shujait Shujait
- Ali Waad
- Alicandro Gianfranco
- Alif Sheikh Mohammad
- Aljunid Syed Mohamed
- Alla François
- Almustanyir Sami
- Alomari Mahmoud A
- Alonso Jordi
- Alqahtani Jaber S
- Alqutaibi Ahmed Yaseen
- Alrawashdeh Ahmad
- Alrousan Sahel Majed
- Alshahrani Najim Z
- Altaany Zaid
- Altaf Awais
- Altirkawi Khalid A
- Aluh Deborah Oyine
- Alvis-Guzman Nelson
- Alvis-Zakzuk Nelson J
- Alwafi Hassan
- Aly Hany
- Aly Safwat
- Alzoubi Karem H
- Amaechi Uchenna Anderson
- Aman Mohammadi Masous
- Amani Reza
- Amiri Sohrab
- Amirzade-Iranaq Mohammad Hosein
- Ammirati Enrico
- Amu Hubert
- Amugsi Dickson A
- Amusa Ganiyu Adeniyi
- Ancuceanu Robert
- Anderlini Deanna
- Anderson Jason A
- Andrade Pedro Prata
- Andrei Catalina Liliana
- Andrei Tudorel
- Anenberg Susan C
- Angappan Dhanalakshmi
- Angus Colin
- Anil Abhishek
- Anil Sneha
- Anjum Afifa
- Anoushiravani Amir
- Antonazzo Ippazio Cosimo
- Antony Catherine M
- Antriyandarti Ernoiz
- Anuoluwa Boluwatife Stephen
- Anvari Davood
- Anvari Saeid
- Anwar Saleha
- Anwar Sumadi Lukman
- Anwer Razique
- Anyabolo Ekenedilichukwu Emmanuel
- Anyasodor Anayochukwu Edward
- Apostol Geminn Louis Carace
- Arabloo Jalal
- Arabzadeh Bahri Razman
- Arafat Mosab
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- Zhang Meixin
- Zhang Yunquan
- Zhang Zhenyu
- Zhang Zhi-Jiang
- Zhao Hanqing
- Zhao Jeff T
- Zhao Xiu-Ju George
- Zhao Yang
- Zhao Yong
- Zheng Peng
- Zhong Chenwen
- Zhou Jingjing
- Zhou Juexiao
- Zhou Shangcheng
- Zhu Bin
- Zhu Lei
- Zhu Zhaohua
- Ziaeian Boback
- Ziafati Makan
- Zielińska Magdalena
- Zimsen Stephanie R M
- Zoghi Ghazal
- Zoller Thomas
- Zumla Alimuddin
- Zyoud Sa'ed H
- Zyoud Samer H
- Publication venue
- Publication date
- 01/01/2024
- Field of study
Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
- Author
- Abad-Motos Ane
- Abbas Ahmed M.
- Abbas Mostafa
- Abbasi Mujeeb
- Abbott Tom
- Abd Karim Muhammad Fairuz Shah
- Abdalaal Ibrahim
- Abdel-Galil Khalid
- Abdelemam Rania
- Abdelgawad Abdalrahman
- Abdelkarim Maryam
- Abdelkhalek Mohamed
- Abdelmageed Abdelfatah
- Abdelmawgoud Sherif
- Abdelmohsen Sarah
- Abdelrahman Ahmed Saber
- Abdelrahman Mostafa
- Abdelwahab Khaled
- Abdou Hossam
- Abdulai Darling Ramatu
- Abdulkhaleq Marwa
- Abdullah Bahiyah
- Abdulsalam Khalifa
- Abdulsalam Shuaib
- Abdur-Rahman Lukman
- Abdus-Salam Rukiyat
- Abdussalam Hameedat Opeyemi
- Abebrese John Tabiri
- Abeldaño Ariel
- Abou-Khalil Jad
- Abou-Taleb Hisham
- Abozid Anwaar
- Abozied Hesham
- Abrate Alberto
- Abu-Zaid Ahmed
- Abubakar Mohammed Kabir
- Abud Burçin
- Abuzaid Mohammed
- Adam Albushra Altayeb
- Adamina Michel
- Adamou Harissou
- Adamu Auwal
- Adamu Kabir Musa
- Adanu Kekeli
- Adebara Idowu
- Adebola Oluwaseyi
- Ademuyiwa Adesoji
- Adeniran Abiodun
- Adepiti Akinfolarin
- Aderogba Adeleke Akeem
- Adesunkanmi Abdulhafiz
- Adeyeye Ademola
- Adisa Adewale
- Adjeso Theophilus Justus Kofi
- Ads Adel Mohamed
- Ads Alaa Mohamed
- Adu-Aryee Nii Armah
- Adumah Collins
- Afzal Irrum
- Agapov Mikhail
- Agarwal Gaurav
- Agarwal Ravi
- Agbeko Anita Eseenam
- Agbeno Evans Kofi
- Agbonrofo Peter
- Agboola Oluseyi
- Aggarwal Gaurav
- Aghadi Ifeanyi
- Aghtarafi Natasha
- Agrawal Amit
- Agresta Ferdinando
- Aguado Héctor J.
- Aguilera-Arevalo Maria-Lorena
- Aherne Thomas
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- Rokohl Alexander Christopher
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- Rolinger Jens
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- Sabbagh Abdulrahman J.
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- Seyi-Olajide Justina
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- Shoukrie Shoukrie I. M.
- Shrestha Rashmit
- Siboe Mark
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- Singer Georg
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- Thaha Mohamed Adhnan
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- Vásquez Javier Alberto Gutiérrez
- Vázquez Gil
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- Vǎcǎraşu Andrei Bogdan
- Wade Ryckie
- Wafi Omar
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- Wallis Christopher
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- Waqar Shahzad Hussain
- Warden Claire
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- Wasserman Isaac
- Watcyn-Jones Tom
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- Watson Matthew
- Weber Clemens
- Wheatstone P.
- Wheeler James
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- Widmer Lukas Werner
- Wiedemann Dominik
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- Wilkins Alex
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- Winnand Philipp
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- Wolde Amanuel
- Wolfenden John W. D.
- Wong Benjamin Ngie Xiong
- Wong Enoch
- Wong Evan G.
- Wong George Kwok Chu
- Wong Ho Ying Flora
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- Wormald Justin
- Wright Deborah
- Wright Joshua
- Wu Fiona
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- Yadev Ip
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- Yanowsky-Reyes Guillermo
- Yassin Abubaker
- Yates Elizabeth
- Yebes Alvaro
- Yenli Edwin Mwintiereh Ta-Ang
- Yeoh Tien
- Yeung Justin
- Yiallourou Anneza
- Yigit Banu
- Yildirim Asif
- Yim Guang
- Yiu Andrew
- Yonekura Hiroshi
- Yotsov Tsanko
- Younis Muhammad Umar
- Yunus Alif
- Yusefi Hossein
- Zabaleta Jon
- Zabkiewicz Catheriner
- Zaccaria Giulia
- Zacharia Bincy
- Zafar Syed Nabeel
- Zago Mauro
- Zaheen Zakia
- Zahid Zahra
- Zaimis Tilemachos
- Zakaria Andee Dzulkarnaen
- Zambon Martina
- Zamora Lindsey
- Zampogna Biagio
- Zancana Giuseppa
- Zani Augusto
- Zanin Luca
- Zanini Nicola
- Zapardiel Ignacio
- Zapata Carlos Shiraishi
- Zarif Pierre
- Zaránd Attila
- Zehnder Philipp
- Zenger Serkan
- Zenha Horácio
- Zhu Michael Z. L.
- Ziemann Sebastian
- Zimak Danijela Mrazovac
- Zimak Zoran
- Zivkovic Dragana
- Zizzo Maurizio
- Zucker Benjamin
- Zwain Yasir
- Zyskowski Michael
- Ávila Clara Castro
- Älgå Andreas
- Çakici Mehmet Çaǧlar
- Çelik Enes
- Çelik Meryem Nur
- Özçay Necdet
- Şevik Hüsnü
- Šantak Goran
- Šimko Kristián
- Žatecký Jan
- Publication venue
- 'Oxford University Press (OUP)'
- Publication date
- 01/01/2023
- Field of study
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
A comparative analysis of teenagers and older pregnant women in the utilization of prevention of mother to child transmission [PMTCT] services in, Western Nigeria
- Author
- A Fletcher
- A McLeod
- A Medley
- B Lopman
- BT Johnson
- CDC
- CDC
- Centers for Disease Control and Prevention (CDC)
- CM Lyles
- D Bryceson
- D Kirby
- D Kirby
- E Allen
- EM Stringer
- Federal Ministry of Health
- Francis A Oluwole
- GB Slap
- GC Jayaraman
- GR Gupta
- IC Anochie
- J Stover
- JD Auerbach
- Joint United Nations Programme on HIV/AIDS
- K James
- K Wellings
- L Robin
- LA Guay
- LM Mofenson
- MG Fowler
- Ministry of Health (MOH) [Uganda] and ORC Macro
- ML Cruz
- Olorunfemi E Amoran
- Omotayo F Salami
- P Gaillard
- PD Mullen
- R Kane
- S Cheesbrough
- S Clark
- S Kristensen
- UNAIDS
- WHO
- WHO & UNICEF
- WHO UNAIDS, & UNICEF
- WM Simpson
- Publication venue
- BMC
- Publication date
- 01/01/2012
- Field of study
<p>Abstract</p> <p>Introduction</p> <p>Most HIV/AIDS infections in women occur at a younger age, during the first few years after sexual debut. This study was therefore designed to assess factors associated with the knowledge and utilization of the prevention of mother-to-child transmission (PMTCT) services by the teenage pregnant women when compared to mature pregnant women in Ogun state, Nigeria.</p> <p>Methods</p> <p>This study is an analytical cross-sectional study. A total sample of all pregnant women [52 teenagers and 148 adults] attending the primary health care centres in Sagamu local government area, Ogun State, Nigeria within a 2 months period were recruited into the study.</p> <p>Results</p> <p>A total of 225 respondents were recruited into the study. The overall point prevalence of HIV/AIDS infection among those that had been tested and disclosed their result was 4 [2.8%]. The prevalence of HIV among the teenagers was 2 [7.4%] compared with 2 [1.8%] among older women. Only 85 [37.8%] of all respondents were tested through the Voluntary counseling and testing (VCCT) programme and 53 (23.7%) were aware of antiretroviral therapy while 35 (15.6%) have ever used the PMTCT services before.</p> <p>There was no statistically significant difference in the knowledge of the teenage pregnant women when compared with the older women about mother to child transmission (MTCT) [OR = 1.47, C.I = 0.57-3.95] and its prevention [OR = 0.83, C.I = 0.38-1.84]. The teenagers were 3 times less likely to use the services when compared with the older women. [OR = 0.34, C.I = 0.10-1.00]. Those from the low socio-economic background were about 6 times more likely to utilize PMTCT facilities when compared to those from high socioeconomic background [OR = 6.01, C.I = 1.91-19.19].</p> <p>Conclusion</p> <p>The study concludes that the teenage pregnant women who were more vulnerable to HIV/AIDS infection did not utilize PMTCT services as much as the older pregnant women. Special consideration should be given to teenagers and those from high socioeconomic group in the design of scale up programmes to improve the uptake of PMTCT services in Nigeria and other low income countries.</p
Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021
- Author
- Aadam Olalekan Bodunrin (18346572)
- Aanuoluwa James Salemcity (18803035)
- Aaron J Cohen (8673585)
- Abbas Mosapour (9154247)
- Abdallah HA Abd Al Magied (18802573)
- Abdallah M Samy (8383428)
- Abdallah Y Naser (18347016)
- Abdelghani Tbakhi (12229742)
- Abdoljalal Marjani (18346929)
- Abdorrahim Absalan (18578551)
- Abdul Hafiz (89029)
- Abdul Wadood Wadood (18803098)
- Abdul Waris (712246)
- Abdulaal Chitheer (8673570)
- Abdulahi Opejin Opejin (18802957)
- Abdulaziz T Bako (18346515)
- Abdulfatai Aremu (9536881)
- Abdulqadir J Nashwan (17991280)
- Abera M Mersha (12150669)
- Abhinav Singh (358909)
- Abhishek Anil (17937800)
- Abhishek Shankar (18207631)
- Abid Ali (3123210)
- Abida Sultana (8147670)
- Abiola Ogunkoya (17255770)
- Abu Sayeed (195793)
- Abubakar Ibrahim Jatau (7623503)
- Abzal Zhumagaliuly (17612982)
- Adalia I Ikiroma (18802801)
- Adam Saddler (386039)
- Adarsh Raja (17612754)
- Adedapo Wasiu Awotidebe (18802633)
- Adel Ali Saeed Al-Gheethi (18267274)
- Adel B Elmoselhi (18802711)
- Adel Hajj Ali (18802777)
- Adeniyi Francis Fagbamigbe (4344979)
- Adesola Adenike Ogunfowokan (18802948)
- Adnan Kisa (6419198)
- Adquate Mhlanga (18346968)
- Adrian Otoiu (9714965)
- Adriana Dima (18346644)
- Afeez Abolarinwa Salami (18059419)
- Afisu Basiru (18346530)
- Ahamarshan Jayaraman Nagarajan (9154253)
- Ahmad Alrawashdeh (8672271)
- Ahmad Azam Malik (6166283)
- Ahmad Ozair (11358042)
- Ahmad Pour-Rashidi (17030889)
- Ahmed I Hasaballah (9154109)
- Ahmed Ismail Mohamed (18346986)
- Ahmed Mustafa Rashid (12159296)
- Ahmed Yaseen Alqutaibi (11438932)
- Akhilanand Chaurasia (12229490)
- Akila Prashant (433606)
- Akinkunmi Paul Okekunle (7492583)
- Akram Al-Ibraheem (17257081)
- Akshaya Srikanth Bhagavathula (7405757)
- Ala'a B Al-Tammemi (18802612)
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- Alberto Freitas (4784418)
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- Alexander G Mathioudakis (18301831)
- Alexios-Fotios A Mentis (12229619)
- Ali Ardekani (11010866)
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- Alicia Padron-Monedero (11875439)
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- Allen Seylani (10195494)
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- Ana-Maria Musina (12258489)
- Anamika Pandey (2575252)
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- Anayochukwu Edward Anyasodor (12229430)
- Anca Mihaela Pantea Stoian (18347094)
- Anders O Larsson (9714878)
- Andre Faro (8383188)
- Andre Rodrigues Duraes (9714668)
- Andrea Carugno (18346584)
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- Andrew T Olagunju (6568496)
- Angelo Capodici (12095986)
- Anh Hoang Nguyen (18802924)
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- Annie Haakenstad (673009)
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- Anton A Artamonov (13268538)
- Antonella Agodi (638417)
- Antonina V Starodubova (18347280)
- Antonio Mazzotti (10157512)
- Antonio Mirijello (4818981)
- Anupam Sharma (4433434)
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- Xiaoqi Feng (380224)
- Xiu-Ju George Zhao (9715217)
- Xuefeng Liu (130787)
- Yafei Si (6902174)
- Yang Zhao (39052)
- Yanqing Wang (250075)
- Yanzhong Wang (51838)
- Yasaman Taheri Abkenar (18803074)
- Yaser Mohammed Al-Worafi (12164582)
- Yashendra Sethi (18347232)
- Yasir Waheed (8383494)
- Yasith Mathangasinghe (6657587)
- Yasser Bustanji (2412991)
- Yazan Al-Ajlouni (18802594)
- Yeshambel T Nigatu (9714956)
- Yi Feng Wen (6760277)
- Yi Song (105202)
- Yihun Mulugeta Alemu (2608216)
- Yinka Doris Oluwafemi (18802954)
- Yo Han Lee (12150657)
- Yohannes Habtegiorgis Abate (18241429)
- Yong Yu (170886)
- Yosef Manla (16940773)
- Yoseph Leonardo Samodra (12150708)
- Yousef Moradi (9626755)
- Yuan-Pang Wang (184231)
- Yuichiro Yano (610246)
- Yun Jin Kim (2133199)
- Yunquan Zhang (4815927)
- Yuta Hiraike (9437181)
- Yuyi You (107083)
- Zahid A Butt (8383149)
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- Zenghong Wu (11946536)
- Zhaoli Dai (10774109)
- Zheng Feei Ma (10142570)
- Zhiqiang Zhang (1522858)
- Zhongyi Zhao (9019268)
- Ziyad Al-Aly (2266126)
- Zombor Berezvai (17255671)
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- Áurea M Madureira-Carvalho (18346908)
- Publication venue
- Publication date
- 16/05/2024
- Field of study
BackgroundFuture 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.MethodsUsing 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.FindingsIn 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]).InterpretationGlobally, 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.FundingBill & Melinda Gates Foundation.</p
Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries
- Author
- A Yacoub Mina
- A. Adam Mohammed
- A. Nassar Mahmoud
- A.Nemer Ayoob
- Aahlin Eirik Kjus
- Ab Rahim Mohd Fadliyazid
- Abad Gurumeta Alfredo
- Abad-Motos Ane
- Abang Jamari Dyg Zahratul Hamrak
- Abantanga Francis
- Abarca Sol
- Abazid Eias
- Abbas Abbas
- Abbas Khalid
- Abbas Mohammad Monir
- Abbasy Jibran
- Abbosh Ali
- Abd Karim Muhammad Fairuz Shah
- Abd Wahab Haidar Hadri
- Abd Barook
- Abdalei Abdulwahab
- Abdalla Ahmed Elkamel Ahmed
- Abdallah Aya
- AbdAllah Mostafa Salim Mohamed
- Abdel Malik Abu Baker
- Abdelhady Mousa Heba
- Abdelhady Samar
- Abdelhakim Ahmed
- Abdelkader Muhammad
- Abdelkawy Shaza
- Abdelkhalek Mohamed
- Abdellatif Esraa
- Abdelmaksoud Tawakel Noura
- Abdelmohsen Naglaa
- Abdelmotaleb Ibrahem
- Abdelrazek Aly
- Abdelsalam Israa
- Abdelshakour Mahmoud
- Abdelwahed Ahmed Mohamed
- Abdou Abdulrahman Osama
- Abdou Alrawy
- Abdou Hossam
- Abdul Aziz Mohamed Rezal
- Abdul Aziz Nora
- Abdulgawad Almogy Mariam
- Abdulla Mazin A.
- Abdullah Muhammad Tariq
- Abdullahi Lawal
- Abdullayev Seymur
- Abed Saeed
- Abelló David
- Abiola Olajide
- Abo mahadi Asmaa'
- Abo-khammash Areej
- Abou Chaar Mohamad K.
- Abou El.soud Moustafa Ramadan
- Abouelsoad Nervana
- Abraham Joyner
- Abreu da Silva Alberto
- Abu Ahammala Ayman B.
- Abu Al Amrain Mahmoud
- Abu Al-saleem Hasan
- Abu Alamrain Abdulwhhab
- Abu Alqumboz Amjad
- Abu Ataya Ahmed
- Abu hallalah Muad fathi khalleefah
- Abu Jamie Najlaa
- Abu Jayyab Israa
- Abu shua'ib Rana
- Abu Zainah Baraa
- Abu-Nimeh Samar
- Abu-Rous Mohammed R.
- Abu-srour Abrar
- Abuelhatal Hasan
- Abuelqomboz Ayham
- Abuhilal Baseel
- Abuhlaiga Ma'aly
- Abujamra Saleh
- Abukhalaf Sadi A.
- Abusalem Lana
- AbuSirrees Mahmoud
- Acevedo Veronica
- Acharya Rajgopal
- Achkasov Sergey
- Acosta Eric
- Adamo Karin
- Adamou Harissou
- Adams Jamie
- Adams Lawrence
- Adawi Samer
- Adebanjo Ademola
- Adel Marina
- Adel Sawsan
- Ademuyiwa Adesoji
- Ademuyiwa Adesoji
- Adenuga Adedire
- Aderounmu Adewale
- Adesanya Opeoluwa
- Adesina Alaba
- Adesunkanmi Abdul-Rashid
- Adeyeye Ademola
- Adidharma Peter
- Adisa Adewale O
- Adnan Nour
- Afifi Amr Abdelghani
- Afifi Eman
- Afolayan Michael Olatunji
- Afzal Asma
- Agarwal Arnav
- Agarwal Raksheeth
- Agbakwuru Augustine
- Agbeko Anita Eseenam
- Aguilar Martinez Maria Del Mar
- Aguilera Maria Lorena
- Aguilera-Arevalo Maria-Lorena
- Ahlqvist Sandra
- Ahmad Izzuddin Ahmad Imran
- Ahmad Kasim
- Ahmad Sarwat
- Ahmed Ahmedgaber
- Ahmed Hazem Abdelkarem
- Ahmed Mariam
- Ahmed Nabila
- Ahmed Zahra
- Ainoa Eppu
- Aithie Joanna M S
- Ajani Costanza
- Ajao Akinlabi
- Ajiboye Anthony
- Ajmera Ankit
- Akande Oluwatosin
- Akaydin Elif
- Akbaba Ata Cem
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- Akin Alp
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- Al Nassrallah Majdi
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- Al Saqqa Sara
- Al-Allaf Omar
- Al-Busaidi Ibrahim S.
- Al-Dhufri Ali
- Al-Himyari Hamza S.
- Al-Masri Mahmoud
- Al-Najjar Hani
- Al-Sabbagh Yusra
- Al-Shwaikh Samar
- Al-Slaibi Ibrahim
- Al-Taher Raed
- Al-Tammam Hiba
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- Alqadi Mohammad
- Alsaid Bayan
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- AlTaweel Mohammed
- Althini Abdulmunem Ahmed Mustafa
- Altibi Ahmed M.
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- Alvarez Rivera Alvaro Eduardo
- Alvarez-Cano Alethia
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- Alwali Abdallah
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- Alzahaf Ahmed
- AlZohour Mohammad
- Amadou Magagi Ibrahim
- Amandito Radhian
- Amarin Justin Z.
- Amaro Margarida
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- Anwar Mohamed
- Anwer Abdul Wahid
- Anyanwu Chikamuche
- Anyanwu Lofty-John
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- Anyomih Theophilus Teddy Kojo
- Appukuttan Akhila
- Aquilino Fabrizio
- Archibald Jess
- Arciénega Yañez María del pilar
- Argentou Maria-Ioanna
- Argudo Nuria
- Argyriou Eleftherios Orestis
- Arias Madrid Natalia
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- Arizpe Daniel
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- Asta Martina
- Asti Emanuele Luigi Giuseppe
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- Atallah Khalid
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- Atawneh Mohammad
- Athamneh Sarah
- Ather Muaaz
- Athisayaraj Thomas
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- Au Angela
- Awad Israa
- Awadallah Haneen
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- Ayau Fernanda
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- Baggaley Caitlin
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- Baiao José Miguel
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- Bake Jacques
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- Balata Mohamed
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- Barreda Zelaya Lilian Elizabeth
- Barrera López Francisco Javier
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- Barter Charlotte
- Bartosiak Katarzyna
- Basarab Maksym
- Basso Stefano Maria Massimiliano.
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- Bath Michael
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- Bedada Alemayehu Ginbo
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- Belal qadomi Asef
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- Belli Andrea
- Beltrán de Heredia Juan
- Belvedere Angela
- Ben Dallah Najah
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- Bhatti Muhammad Iqbal
- Bianchini Stefania
- Bianco Francesco
- Bibas Fatma
- Biccard Bruce M
- Bielosludtsev Oleksii
- Bienfait Mumbere
- Billy Matthew
- Bin Mohamad Sithik Muhammad Navid
- Binetti Margherita
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- Bird Jonathan
- Birindelli Arianna
- Birks Sarah
- Birutis Justas
- Björklund Ida
- Blackman Brighid
- Blackwell James
- Blanco-Colino Ruth
- Blok Robin
- Blomme Nina
- Blomqvist Malin
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- Bogusevicius Algirdas
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- Bonavina Luigi
- Bondurri Andrea
- Bonghaseh Divine Tim
- Bono Lorenzo
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- Borg Elaine
- Borghi Felice
- Borham Hala
- Borowski David W
- Bortolasi Luca
- Bosch Marina
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- Bossi Daniela
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- Bougard Heather
- Boutall Adam
- Boutros Marylise
- Bouzaiene Hatem
- Boyce Stephen
- Boyd-Carson Hannah
- Boyle Connor
- Braccio Bartolomeo
- Bradulskis Saulius
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- Brooker Ethan
- Brooks Savannah
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- Bury Pawel
- Busuttil Zachary
- Butt Eman
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- Buzaite Kristina
- C S Archana
- Caballero Díaz Yurena
- Cabrera Rivera Paulo Andrés
- Cagigas Fernandez Carmen
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- Camelo Saul
- Camilo Correa Juan
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- Carvalho Lúcia
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- Castaldi Antonio
- Castanedo Bezanilla Sonia
- Castilla Moreno Miguel Angel
- Castillo Arrascue José Neiser
- Castillo Barbosa Andrea Carolina
- Castro López Elizabeth Victoria
- Castro Ernes John
- Castro Luis
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- Cañete Joannes Paul
- Ceballos André
- Celebioglu Fuat
- Celentano Valerio
- Cenal Ulukan
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- Chacòn-Herrera Patricia
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- Cirillo Bruno
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- Clements Hollie A
- Clements Joshua Michael
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- Corrigan Robert
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- Costa Santos Daniel
- Costa Santos Maria Teresa
- Costa-Maia Jose
- Costanzo Antonio
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- Coulter-Nile Sarah Michelle Crystal Jade
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- Dawidziuk Aleksander
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- Zulu Stanley
- Ângelo Miguel
- Älgå Andreas
- Çolak Elif
- Ümarik Toomas
- Šatkauskas Mindaugas
- Škimelyte Monika
- Šlenfuktas Vygintas
- Šuman Oliver
- Žatecký Jan
- Žumbakys Žygimantas
- Župan Domagoj
- Publication venue
- 'Elsevier BV'
- Publication date
- 30/01/2021
- Field of study
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit
Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study
- Author
- A Yacoub Mina
- A. Adam Mohammed
- A. Nassar Mahmoud
- A.Nemer Ayoob
- Aahlin Eirik Kjus
- Ab Rahim Mohd Fadliyazid
- Abad Gurumeta Alfredo
- Abad-Motos Ane
- Abang Jamari Dyg Zahratul Hamrak
- Abantanga Francis
- Abarca Sol
- Abazid Eias
- Abbas Abbas
- Abbas Khalid
- Abbas Mohammad Monir
- Abbasy Jibran
- Abbosh Ali
- Abd Karim Muhammad Fairuz Shah
- Abd Wahab Haidar Hadri
- Abd Barook
- Abdalei Abdulwahab
- Abdalla Ahmed Elkamel Ahmed
- Abdallah Aya
- AbdAllah Mostafa Salim Mohamed
- Abdel Malik Abu Baker
- Abdelhady Mousa Heba
- Abdelhady Samar
- Abdelhakim Ahmed
- Abdelkader Muhammad
- Abdelkawy Shaza
- Abdelkhalek Mohamed
- Abdellatif Esraa
- Abdelmaksoud Tawakel Noura
- Abdelmohsen Naglaa
- Abdelmotaleb Ibrahem
- Abdelrazek Aly
- Abdelsalam Israa
- Abdelshakour Mahmoud
- Abdelwahed Ahmed Mohamed
- Abdou Abdulrahman Osama
- Abdou Alrawy
- Abdou Hossam
- Abdul Aziz Mohamed Rezal
- Abdul Aziz Nora
- Abdulgawad Almogy Mariam
- Abdulla Mazin A.
- Abdullah Muhammad Tariq
- Abdullahi Lawal
- Abdullayev Seymur
- Abed Saeed
- Abelló David
- Abiola Olajide
- Abo mahadi Asmaa'
- Abo-khammash Areej
- Abou Chaar Mohamad K.
- Abou El.soud Moustafa Ramadan
- Abouelsoad Nervana
- Abraham Joyner
- Abreu da Silva Alberto
- Abu Ahammala Ayman B.
- Abu Al Amrain Mahmoud
- Abu Al-saleem Hasan
- Abu Alamrain Abdulwhhab
- Abu Alqumboz Amjad
- Abu Ataya Ahmed
- Abu hallalah Muad fathi khalleefah
- Abu Jamie Najlaa
- Abu Jayyab Israa
- Abu shua'ib Rana
- Abu Zainah Baraa
- Abu-Nimeh Samar
- Abu-Rous Mohammed R.
- Abu-srour Abrar
- Abuelhatal Hasan
- Abuelqomboz Ayham
- Abuhilal Baseel
- Abuhlaiga Ma'aly
- Abujamra Saleh
- Abukhalaf Sadi A.
- Abusalem Lana
- AbuSirrees Mahmoud
- Acevedo Veronica
- Acharya Rajgopal
- Achkasov Sergey
- Acosta Eric
- Adamo Karin
- Adamou Harissou
- Adams Jamie
- Adams Lawrence
- Adawi Samer
- Adebanjo Ademola
- Adel Marina
- Adel Sawsan
- Ademuyiwa Adesoji
- Ademuyiwa Adesoji O
- Adenuga Adedire
- Aderounmu Adewale
- Adesanya Opeoluwa
- Adesina Alaba
- Adesunkanmi Abdul-Rashid
- Adeyeye Ademola
- Adidharma Peter
- Adisa Adewale
- Adisa Adewale O
- Adnan Nour
- Afifi Amr Abdelghani
- Afifi Eman
- Afolayan Michael Olatunji
- Afzal Asma
- Agarwal Arnav
- Agarwal Raksheeth
- Agbakwuru Augustine
- Agbeko Anita Eseenam
- Aguilar Martinez Maria Del Mar
- Aguilera Maria Lorena
- Aguilera-Arevalo Maria-Lorena
- Ahlqvist Sandra
- Ahmad Izzuddin Ahmad Imran
- Ahmad Kasim
- Ahmad Sarwat
- Ahmed Ahmedgaber
- Ahmed Hazem Abdelkarem
- Ahmed Mariam
- Ahmed Nabila
- Ahmed Zahra
- Ainoa Eppu
- Aithie Joanna M S
- Ajani Costanza
- Ajao Akinlabi
- Ajiboye Anthony
- Ajmera Ankit
- Akande Oluwatosin
- Akaydin Elif
- Akbaba Ata Cem
- Akbar Sana Amir
- Akeel Nouf
- Akeem Aderogba Adeleke
- Akin Alp
- Akinkuolie Akinbolaji
- Akisheva Aygulya
- Akitikori Mabel Temisanren
- Akrida Ioanna
- Aktas Melik Kagan
- Al basos Iyad
- Al Farsi Maryam
- Al Nassrallah Majdi
- Al Sagheir Eman
- Al Saqqa Sara
- Al Saqqa Sara
- Al-Allaf Omar
- Al-Busaidi Ibrahim S.
- Al-Dhufri Ali
- Al-Himyari Hamza S.
- Al-Masri Mahmoud
- Al-Najjar Hani
- Al-Sabbagh Yusra
- Al-Shwaikh Samar
- Al-Slaibi Ibrahim
- Al-Taher Raed
- Al-Tammam Hiba
- Alabuzidi Aya
- Alagha Othman
- Alammarin Mohammad
- Alapatt John
- Alasttal Mohammed
- Alatise Olusegun Isaac
- Albaggar Marwa
- Albahnasawi Moath A.
- Albati Naif
- Alberga Anna
- Alberts Justin
- AlBsoul Ahmad
- Albsoul Nader
- Alcorta Rodrigo
- Alejandre Villalobos Cristina
- Alemdağ Gökçe nur
- Alexander Philip
- Alfarra Nada
- Alfitory Asma
- Alhabil Belal
- Alhaj Ahmad
- Alherz Mohammad
- Alhimyar Maryam
- Ali Ahmad Syed Mustafa
- Ali SANI Samuel
- Ali Amr
- Ali Asmaa
- Ali Mahmoud
- Ali Shabina
- Alimi Marjan
- Aliosin Oleg
- Aliyu Halima
- Aljaafreh Almoutuz
- Aljaber Dana
- Aljaberi Loay
- Aljanfi Asma
- Aljiffry Murad
- Aljohmani Lylas
- Alkhaledi Ahmad
- Alkhatib Ala'a Aldeen
- Alkhatib Haya
- Alkhatib Mo'min
- Allen Ingabire J.C.
- Almasri Murad
- Almeida Braga Sara
- Almeida Filipe
- Almigheerbi Alabas
- Almoqayyad Abdelrahman
- Almuzghi Fakhruddin
- Alnoury Mostafa
- Alonso Batanero Ester
- Alqadi Mohammad
- Alsaid Bayan
- Alsalameh Barah
- Alsallaq Osama
- Alser Osaid
- Alshaar Muhammad
- Alsharef Tagwa
- Alsharqawi Nourah
- Alswerki Mohammad
- Altaf Amna
- Altaf Rabiya
- AlTaweel Mohammed
- Althini Abdulmunem Ahmed Mustafa
- Altibi Ahmed M.
- Altinel Yuksel
- Altiner Saygin
- Altomare Donato Francesco
- Altumei Zohoor
- Alvarez Rivera Alvaro Eduardo
- Alvarez-Cano Alethia
- Alves do Canto Brum Homero
- Alves Daniela Macedo
- Alves Magda
- Alvi Abdul
- Alwaheidi Malak
- Alwali Abdallah
- Alwerfally AbdulMawlay
- Alwhaidi Noor
- Alyafi Amr
- Alzabti Fatima
- Alzahaf Ahmed
- AlZohour Mohammad
- Amadou Magagi Ibrahim
- Amandito Radhian
- Amarin Justin Z.
- Amaro Margarida
- Ambrazevicius Marijus
- Amendola Alfonso
- Amin Leila
- Amine Souadka
- Amjad Talal
- Amorim Edgar
- Amro Adham
- Anandan Premkumar
- Anas khalifa Rawda
- Anastasio Lorenzo
- Andersson Yvette
- Andreotti Dario
- Andrew David
- André Benoît
- Ang Sue Ean
- Angel Miguel
- Anggita Gultom Phebe
- Annapureddy Naga
- Anokhin Evgeny
- Ansaloni Luca
- Ansarei Dhirar
- Ansari Abdul Basit
- Antaky Marco
- Anthony Natasha
- Anthoulakis Christos
- Antonopoulou Maria Ioanna
- Anwar Mohamed
- Anwer Abdul Wahid
- Anyanwu Chikamuche
- Anyanwu Lofty-John
- Anyanwu Mercy Chinemerem
- Anyomih Theophilus Teddy Kojo
- Appukuttan Akhila
- Aquilino Fabrizio
- Archibald Jess
- Arciénega Yañez María del pilar
- Argentou Maria-Ioanna
- Argudo Nuria
- Argyriou Eleftherios Orestis
- Arias Madrid Natalia
- Aribi Sarra
- Arifin Ghafur Rasyid
- Arizpe Daniel
- Arnaud Alexis P
- Arora Bharti
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- Arowolo Olukayode
- Arrangoiz Rodrigo
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- Artigau Eva
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- Ashraf Alaa
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- Asnel Dorisme
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- Assalhi Mohamed
- Asta Martina
- Asti Emanuele Luigi Giuseppe
- Atakul Onur
- Atallah Khalid
- Atanasov Boyko
- Atawneh Mohammad
- Athamneh Sarah
- Ather Muaaz
- Athisayaraj Thomas
- Atkociunas Aivaras
- Attia Mohamed
- Au Angela
- Awad Israa
- Awadallah Haneen
- Awaji Kholoud
- Awesat Eman
- Awolowo Ajibola
- Ayandipo Omobolaji
- Ayash Mohammad
- Ayau Fernanda
- Ayesh Kholoud
- Ayman El-sawy Esraa
- Ayoub Rami
- Aytac Erman
- Ayub Bushra
- Ayub Saima
- Ayyad Rawan
- Azevedo José
- Azodo Ijeoma
- Azzubia Joma
- B L Ashika
- Ba Mouhamadou Bachir
- Babaa Basheer
- Babirye Lilian
- Bacic Ivan
- Badr Esraa Tarek
- Badr Helmy
- Badran Abdul
- Badwe Rajendra
- Bafford Andrea Chao M.D.
- Baggaley Caitlin
- Bahroun Sumayyah Ghayth
- Baiao José Miguel
- Baiocchi Daniella
- Bairos Menezes Maria
- Baiu Ioana
- Bajilan Mohammad
- Bajomo Oreoluwa
- Bake Jacques
- Baki Bahadir Emre
- Bakoleas Panagiotis
- Balaawi Reem
- Balalis Dimitrios
- Balata Mohamed
- Balkarov Artem
- Ballouhey Quentin
- Balogun Olanrewaju
- Baloyiannis Ioannis
- Baltaci Ege
- Bamaca Ixcajoc Elvis Benjamin
- Banaz Tuba
- Banda Bitiel
- Banglani Muntaha
- Bani Hani Farah
- Bani hani Mohammad
- Bani hani Zeina
- Baniowda Muath
- Banks Alexander
- Bannister Sharon
- Baranyai Zsolt
- Barati Nastaran
- Barbosa Camacho Francisco José
- Barbosa José
- Bardos David
- Barendegere Venerand
- Barghuthi Lutfi
- Barhoush Ola
- Barnes Nicole
- Baronio Gianluca
- Barreda Zelaya Lilian Elizabeth
- Barrera López Francisco Javier
- Barsic Neven
- Barter Charlotte
- Bartosiak Katarzyna
- Basarab Maksym
- Basso Stefano Maria Massimiliano.
- Bastiaenen Vivian
- Batashki Ilia
- Bath Michael
- Beattie Miriam
- Bedada Alemayehu Ginbo
- Belais Fanny
- Belal qadomi Asef
- Belev Nikolay
- Belli Andrea
- Beltrán de Heredia Juan
- Belvedere Angela
- Ben Dallah Najah
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- Bengur Fuat Baris
- Benkabbou Amine
- Benke Marton
- Benyaiche Chaymae
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- Beuran Mircea
- Bhandare Manish
- Bhangu Aneel
- Bhatti Muhammad Iqbal
- Bianchini Stefania
- Bianco Francesco
- Bibas Fatma
- Biccard Bruce M
- Bielosludtsev Oleksii
- Bienfait Mumbere
- Billy Matthew
- Bin Mohamad Sithik Muhammad Navid
- Binetti Margherita
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- Dominguez Joaquina
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- Drake Thomas M
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- Eismontas Vitalijus
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- Ekpete Ogbonnia
- Ekwen Gerald
- El Aroussi Nouhaila
- El Gharmoul Tasnim
- El Jamassi Alaa
- El Muhtaseb M.S.
- El Nakeeb Ayman
- El sheikh Enas
- El Zoghby Naira
- El-Kahlout Sahar
- El-remaily Amira
- El-Sawy Aya
- El-taweel Alaa
- Elazab Yasmin
- Elbarouni Sofian
- Elbealawy Mohamed
- Elbeshina Aya Elseed
- Elblbessy Mahmood
- Eldeep Ahmed
- Eldeep Mostafa
- Eldmaty Asmaa
- Eldoseuky mohammed Amany
- Elemile Peter
- Elewaily Mohamed Ibrahim Elsayed
- Elfaituri Taha
- Elfallal Ahmed
- Elfanty Mahmoud
- ElFayoumy Ahmed Moustafa
- Elfeki Hossam
- Elfizri Zatira
- Elgammudi Mala
- Elghareeb Nourhan
- Elhadi Ahmed
- Elhadi Muhammed
- Elhajjaji Yasmine
- Elhelow Esraa
- Elhout Somaya
- Elkabir Osama
- Elkhadragy Ahmed
- Elkhalawy Aya
- Ellaby-Hall Jordan
- Ellul Sarah
- Elmahdy Marwa
- Elmeslemany Nehal
- Elmokadem Aya
- Elqadi Muawiyah
- Elrais Safa
- Elsayed Mai
- Elsayed Mohammad
- Elshafei Houssein
- Elshafey Ahmed
- Elshaibani Mahmoud
- Elshatby Bassant
- Elshawy Mohamed Elemam
- Elsherbeny Mohammed Yasser
- Elsherif Fawzia
- Elshimy Ahmed
- Elsobky Hager
- Elteir Hana
- Eltoum Ruba
- Elzanfaly Ali Abdelazez
- Emara Eman
- Emeghara Okechukwu
- Emile Sameh
- Enumah Zachary
- Eraslan Huseyin
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- Eslam Sara
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- Esposito Giovanni
- Essam Ibrahim El Desouki Muhammad Ahmed Muhammad
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- Fahmawee Toqa
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- Falato Armando
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- Farik Shebani
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- Farooq Muhammad
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- Faustin Ntirenganya
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- Wisselink Daan
- Wogensen Fredrik
- Wondoh Paul M.
- Wong Florence
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- Wong Jane J
- Wong Jeremy
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- Yaghi Yasmine
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- Yakushkina Al'ona
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- Yanikoğlu Erkan
- Yanni Fady
- Yates Charlotte
- Ye Geoffrey
- Yeen Chin Leow
- Yemez Kürşat
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- Yenli Edwin
- Yeo Jeremy
- Yeoh Andrea
- Yepez Raul
- Yeşilsancak Merve
- Yildirim Reyyan
- Yildiz Alp
- Yilmaz Duygu
- Yip Ching Wan
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- Yong Shun Qi
- Yoong Andrel
- Yorke Joseph
- Yotsov Tsanko
- You Lucia
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- Yu Kristin
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- Yusuf Baasil
- Yüksel Osman
- Zabiyaka Mikhail
- Zachariah Sanoop Koshy
- Zafar Syed Nabeel
- Zaffaroni Gloria
- Zahra Baryab
- Zahran Diaaaldin
- Zakaria Andee Dzulkarnaen
- Zakaria Mai
- Zakaria Omar
- Zakaria Zaidi
- Zambrana Campos Vanesa
- Zammit Matthew
- Zanini Nicola
- Zara Vlu Jean
- Zarti Heba
- Zarzycki Piotr
- Zattoni Davide
- Zavala Gabriela
- Zawahrah Hassan
- Zeiton Asaid
- Zeko Amanda
- Zeng Zhi
- Zeromskas Paulius
- Zhang Geoffrey
- Zhivkov Evgeni
- Zid Esraa
- Zidan Ahmed Mohy
- Zielasek Christian
- Zilinskas Justas
- Zimmermann Bernd
- Ziprin Paul
- Zizzo Maurizio
- Zografos George
- Zoikas Athanasios
- Zorrilla Matilla Laura Patricia
- Zoulamoglou Menelaos
- Zreeg Dafer
- Zub-Pokrowiecka Anna
- Zubiaurre Vanessa
- Zuhdy Mohammed
- Zuikyte Diana
- Zuloaga Fernandez del Valle Carlos Jose
- Zulu Stanley
- Ângelo Miguel
- Älgå Andreas
- Çolak Elif
- Ümarik Toomas
- Čepuliené Daiva
- Şahin Can
- Šatkauskas Mindaugas
- Škimelytè Monika
- Šlenfuktas Vygintas
- Šuman Oliver
- Žatecký Jan
- Žumbakys Žygimantas
- Župan Domagoj
- Publication venue
- 'Elsevier BV'
- Publication date
- 01/07/2022
- Field of study
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research