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

Prolonging the postharvest life of papaya using modified atmosphere packaging

. (2011). Prolonging the postharvest life of papaya using modified atmosphere packaging. Journal of Agricultural Technology 7(2): 507-518. The papaya fruit occupies a prominent position among the fruit crops grown in Sri Lanka. The effectiveness of controlling the post harvest diseases of fresh papaya variety 'Rathne' was subjected to different pre-treatments and enclosing in sealed bags made out of 0.075mm low density polyethylene (LDPE) that was evaluated under prevailing ambient conditions (31±2 o C and 65±5% RH). As pre-treatments, hot water dipping at 49 o C for 20 min. followed by spraying with 1, 3, 5 and 7% ethanol were carried out. The effectiveness of the treatments was determined by measuring the physico-chemical properties and subjective parameters namely, disease index and peel color index. The effectiveness of magnesium oxide (MgO) and potassium permanganate (KMnO 4 ) in modifying the in-package gaseous atmosphere to extend the post harvest life was also determined. The control fruit, which was kept without packaging or any pre-treatment deteriorated after 6 days while hot water dipping and spraying with 5% ethanol followed by packaging in 0.075mm LDPE was effective in extending the post harvest life of papaya up to 12 days under ambient conditions. On the other hand, MgO did not have any influence on altering the CO 2 concentrations in the in-package gaseous atmosphere and hence was not effective as a CO 2 scavenger. KMnO 4 was effective as an ethylene scavenger. Papaya enclosed in LDPE bags with KMnO 4 after subjecting to hot water dipping (49 o C) for 20 min, followed by spraying 5% ethanol was effective in extending the post harvest life up to 12 days