Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background 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

Correlation between different Scheimpflug-based lens densitometry analysis and effective phacoemulsification time in mild nuclear cataracts

To assess the correlations between preoperative Scheimpflug-based lens densitometry and effective phacoemulsification time (EPT) in age-related nuclear cataracts.Purpose To assess the correlations between preoperative Scheimpflug-based lens densitometry and effective phacoemulsification time (EPT) in age-related nuclear cataracts. Design Retrospective consecutive study. Methods The setting was the Ophthalmology Department, Hospital de Braga, Portugal. The study population included 50 eyes (42 patients) with age-related nuclear cataracts submitted to uneventful phacoemulsification surgery. Different analysis methods of Scheimpflug-based lens densitometry were performed: Pentacam Nucleus Staging (PNS) score with an ordinal scale from 0 to 5 and three-dimensional (3D), linear and region of interest (ROI) methods, which are displayed on an absolute scale (from 0 to 100%). EPT was calculated for the cataract surgery, which was performed by the same surgeon. Correlations between lens densitometry variables and EPT were determined using Pearson or Spearman correlation coefficients according to data normality. Results There were significant correlations between EPT and average density and maximum density variables derived from the 3D (r = 0.596, p < 0.001; r = 0.632, p < 0.001, respectively) and ROI (r = 0.527, p < 0.001; r = 0.575, p < 0.001, respectively) methods. The average density was the only parameter derived from the linear analysis that showed a significant correlation with EPT (r = 0.293, p = 0.039). The PNS score did not show a significant correlation with EPT (rho = 0.124, p = 0.390). Conclusion The densitometric parameters based on the 3D method showed the highest correlations with EPT. The referred lens densitometric analysis approach may be used in preoperative assessment in order to predict EPT more efficiently in age-related nuclear cataractsinfo:eu-repo/semantics/publishedVersio