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

Simulation of spray coating in a spouted bed using recurrence CFD

Although numerical models such as the computational fluid dynamics–discrete element method(CFD–DEM) have enabled the accurate simulation of laboratory-scale apparatuses, the application ofthese methods to large-scale apparatuses with many particles and time scales ranging from minutes tohours remains a challenge. The recently developed recurrence CFD (rCFD) method seeks to overcomethese issues in pseudo-periodic processes by extrapolating globally recurring patterns in a physicallymeaningful way and describing the transport and interaction of passive scalars using Lagrangian tracers.Spouted beds represent an interesting target because of the associated variety of flow regimes. They canbe effectively described by CFD–DEM on the time scale of tens of seconds, whereas industrially relevantprocesses typically take hours. In this contribution, we established the validity of applying the LagrangianrCFD method to spouted beds by demonstrating the accurate reproduction of the particle residence timedistribution in a fictitious spray zone. The deposition of spray droplets onto tracer particles was simulatedfor 1 h, and the particle surface coverage distribution was estimated using a statistical approach for bothan unstabilized prismatic spouted bed and one stabilized by draft plates.Linz Instituteof Technology (LIT)Johannes Kepler University (project LIT-2016-1-YOU-007)BASF S

BMC Nephrology / Urinary [TIMP-2] [IGFBP-7] for predicting acute kidney injury in patients undergoing orthotopic liver transplantation

Background The product of the concentrations of urinary tissue inhibitor of metalloproteinases-2 and insulin-like growth factor binding protein-7 (urinary [TIMP-2][IGFBP-7]) has been suggested as biomarker for early detection of acute kidney injury (AKI) in various clinical settings. However, the performance of urinary [TIMP-2][IGFBP-7] to predict AKI has never been assessed in patients undergoing orthotopic liver transplantation (OLT). Thus, the aim of this study was to assess the early predictive value of urinary [TIMP-2][IGFBP-7] for the development of AKI after OLT. Methods In this observational study, urinary [TIMP-2][IGFBP-7] was measured in samples from adult OLT patients. AKI was diagnosed and classified according to KDIGO criteria. Areas under the receiver operating curves (AUC) were calculated to assess predictive values of urinary [TIMP-2][IGFBP-7] for the development of AKI. Results Forty patients (mean age 558years) were included. Twenty-eight patients (70%) developed AKI stage 1, 2, or 3 within 48h after OLT. Urinary [TIMP-2][IGFBP-7] was not predictive for AKI at the end of OLT (AUC: 0.54, CI [0.320.75], P=0.72), at day 1 (AUC: 0.60, CI [0.410.79], P=0.31), or day 2 after OLT (AUC: 0.63, CI [0.460.8], P=0.18). Conclusion Based on our results, routine clinical use of urinary [TIMP-2][IGFBP-7] cannot be recommended for risk assessment of AKI in patients undergoing OLT.(VLID)489637