7 research outputs found
Palynology from “The Jurassic Dinosaur Coast” of Asturias (Lastres Fm., Northwestern Spain): palynostratigraphical and palaeoecological insights
- Author
- Publication venue
- 'MDPI AG'
- Publication date
- 24/11/2022
- Field of study
Abundant fossils of vertebrates (mainly footprints and bones of dinosaurs) and numerous invertebrates occur in the Upper Jurassic deposits of the Lastres Formation in the Asturias region, North of Spain. However, no palynological study has been published from this geological formation; therefore, much palaeoenvironmental and palaeoecological information is still unknown. In this study, a total of 62 morphospecies, belonging to 49 different morphogenera were identified, including pollen, spores, algae remains, fungi spores, dinoflagellates, foraminifera, and scolecodonts from four different locations on the Asturian coast. Spores are the dominant group of palynomorphs, both in diversity and abundance, contrasting with the minor diversity of pollen grains. The age of some key taxa indicates that the palynological assemblage cannot be older than the Kimmeridgian, suggesting a Kimmeridgian-Tithonian age. The botanical and environmental affinities of the pollen and spores indicate the presence of different plant assemblages, including plant communities from humid areas such as the margin of rivers and small freshwater ponds that were dominated by bryophytes and ferns, and a coastal plant community that would inhabit arid areas and would be dominated by gymnosperms and some pteridophytes. The SEM analyses of wood remains show the abundance of charcoalified remains suggesting that wildfires were usual in The Dinosaur Coast of Asturias during the Kimmeridgian.Xunta de Galicia | Ref. ED481A-2019/243Xunta de Galicia | Ref. ED481A-2020/175Chinese Academy of Sciences | Ref. XDB26000000Ministerio de Ciencia, Innovación y Universidades | Ref. PGC2018-094034-B-C2
Assessing Hydropower Potential under Shared Socioeconomic Pathways Scenarios Using Integrated Assessment Modelling
- Author
- Publication venue
- MDPI
- Publication date
- 01/01/2024
- Field of study
The world is facing a global sustainability crisis affecting environmental systems and society. Addressing these issues requires a multi-dimensional approach that can integrate energy, water, and environment Systems, as well as provide scientific policy advice. In this study, an updated version of an Integrated Assessment Model (IAM) was used, together with new data compatible with Shared Socioeconomic Pathways (SSPs) projections, to significantly improve the work developed before. SSP climate data (temperature, precipitation, and total radiative forcing) and socioeconomic data (population and GDP) were loaded into the IAM, together with different scenario parameters. By analyzing varying socioeconomic scenarios, mitigation efforts, and adaptation strategies, this study assesses their impact on primary energy demand and, consequently, their impact on hydropower potential production. Our results show diverse energy paths, strongly dependent on the future scenario. Energy demand could increase up to 160%; however, several projections foresee a decline in hydropower production to minus 46% due to both climate change and socioeconomic transformation. Our findings highlight the importance of considering a range of potential future scenarios in energy planning and policy development. The varied outcomes across the considered scenarios emphasize the need for flexibility in strategies to accommodate for uncertainties and address the challenges posed by divergent trajectories in hydropower use and renewable energy shares.info:eu-repo/semantics/publishedVersio
La antropología ante el Perú de hoy : balances regionales y antropologías latinoamericanas
- Author
- Anderson Jeanine - Autor/a
- Carpio Torres Juan Bautista - Autor/a
- Chaumeil Jean-Pierre - Autor/a
- Cutipa Añamuro Guillermo - Autor/a
- Degregori Carlos Iván - Autor/a
- Diez Hurtado Alejandro - Autor/a
- Diez Hurtado Alejandro - Compilador/a o Editor/a
- Elías Minaya José F. - Autor/a
- Escalante Gutiérrez Carmen - Autor/a
- Ferrúa Carrasco Freddy - Autor/a
- Gúber Rosana - Autor/a
- Moreno Yánez Segundo E. - Autor/a
- Palacios Ríos Félix - Autor/a
- Peña Guillermo de la - Autor/a
- Robles Mendoza Román - Autor/a
- Salazar-Soler C. - Autor/a
- Valderrama Fernández Ricardo - Autor/a
- Velho Otávio Guilherme - Autor/a
- Álvarez Ramos José Luis - Autor/a
- Publication venue
- 'Dipartimento di Economia, Universita di Perugia (IT)'
- Publication date
- 23/03/2017
- Field of study
Con el propósito de hacer un balance y convocar al mayor número posible de antropólogos e investigadores, buscando actualizar y socializar el conocimiento antropológico sobre el Perú, el congreso convocó cerca de 800 participantes, presentándose 300 ponencias distribuidas en 47 mesas temáticas y tres mesas especiales de balance. El esfuerzo de organización del evento fue muy grande, encargado a una comisión bipartita: tres de San Marcos (Mercedes Giesecke, Román Robles y Rommel Plascencia) y tres de la Católica (Gisela Cánepa, Cecilia Rivera y Alejandro Diez), contó también con la incorporación de un representante del CONCYTEC (Humberto Rodríguez) y otro del INC (Juan José García), a los que se sumó un número muy grande de personas entre colegas, alumnos y autoridades de las dos universidades y muchos colaboradores, amigos y auspiciadores que hicieron que el congreso fuera posible
Discovering HIV related information by means of association rules and machine learning
- Author
- Adsuar Araceli
- Agea Iván
- Agullo Vanessa
- Aiello Francesco
- Alba Verónica
- Albendin Helena
- Alcaraz Antonia
- Alcaraz Begoña
- Aldamiz-Echevarría Teresa
- Alemán M. Remedios
- Algado Jose Tomás
- Alonso M. Mar
- Alonso Noemí
- Amador Concha
- Anguita Francisco
- Antela Antonio
- Aramburu M. José
- Araujo Lourdes
- Arazo Piedad
- Arce Octavio
- Arranz Alberto
- Arribas José Ramón
- Arribas Víctor
- Asensi Víctor
- Ayerdi Oskar
- Azkune Harkaitz
- Ballesteros Juan
- Balsalobre Luz
- Barber Xavier
- Barrios Ana
- Bautista Azucena
- Baza Begoña
- Berenguer Juan
- Bermejo Laura
- Bernal Enrique
- Bernardino Jose Ignacio
- Bisbal Otilia
- Bisbal Otilia
- Blanco José Ramón
- Blanes Marino
- Boix Vicente
- Botella Ángela
- Bravo Joaquín
- Burgos Joaquín
- Busca Carmen
- Bustinduy M. Jesús
- Cabello Alfonso
- Cabello Noemí
- Cairó Mireia
- Calabuig Eva
- Calvet-Mirabent Marta
- Calzado Sonia
- Camacho Ángela
- Camino Xabier
- Campins Antoni A.
- Cano Joanna
- Cardiñanos Julen
- Carrillo Irene
- Carrió Juan Carlos
- Casado José Luis
- Castillo Antonia
- Castro Juan Miguel
- Castro Ángeles
- Catalina Scévola Sofia
- Cervantes Garcia Manel
- Cervero Miguel
- Chueca Natalia
- Ciudad Marianela
- Corma Anais
- Corona Diana
- Corona Diana
- Corral Saray
- Curran Adrián
- Cuéllar Sandra
- Cámara M. Mar
- Dalmau David
- de la Peña Mireia
- de la Torre Javier
- de Lagarde María
- de los Santos Alejandro
- de los Santos Ignacio
- de Miguel Joana
- de Miguel Rosa
- de Salazar Adolfo
- de Zarraga Miguel Alberto
- del Arco Alfonso
- del Campo Santos
- Del Romero Jorge
- Delgado-Hierro Ana
- Descalzo Jorro Vicente
- Diez Cristina
- Dronda Fernando
- Dueñas Carlos
- Díaz-Flores Felicitas
- Egües Xjoylin
- Escosa Luis
- Espineira Sonia
- Espinosa Nuria
- Estrada Vicente
- Falces Iker
- Falcó Vicenç
- Fanciulli Chiara
- Fanjul Francisco J.
- Fernández Juan
- Fernández Marian
- Fernández Marta
- Fernández Marta
- Ferrer Ana
- Ferrero Óscar Luis
- Font Roser
- Frias Mario
- Fuentes Ana
- Fuster Daniel
- Galera Carlos
- Galiana Antonio
- Galindo M. José
- Garcia-Gazalla Mercedes
- García Abellán Javier
- García Dácil
- García Federico
- García Gema
- García Guillermo
- García Jorge
- García Josefina
- García José Alberto
- García Milagros
- García-Fraile Lucio
- García-Pardo Graciano
- Gijón Paloma
- Gil Concepción
- Gil Leire
- Giner Livia
- Goenaga Miguel Ángel
- Goikoetxea Maider
- Gonzalez Candela
- Gonzalez-Serna Alejandro
- González-Baeza Alicia
- González-García Juan
- González-Ruano Patricia
- Gracia María
- Guillén Lucía
- Guirao Emilio
- Gutierrez Isabel
- Gutiérrez Félix
- Gutiérrez Sara
- Gutiérrez Ángela
- Gómez Bertomeu Frederic
- Gómez Cristina
- Gómez Juan Luis
- Gómez M. Amparo
- Górgolas Miguel
- Hermida José Manuel
- Hernando M. Asunción
- Hernández Cristina
- Hernández Jehovana
- Hernández José
- Herranz Pedro
- Herrero Carmen
- Homar Francisco
- Hontañón Víctor
- Ibarguren Maialen
- Ibarra Sofía
- Ibarra Valvanera
- Ibero Carlos
- Iborra Asunción
- Imaz Arkaitz
- Iribarren José Antonio
- Jaén Àngels
- Kortajarena Xabier
- Llaves Silvia
- Lombide Itxaso
- Lopez Iñigo
- Lopez Miriam
- Losada Elena
- López Garcia Belen
- López Lirola Ana
- López Josefina
- López Juan Carlos
- López María
- López Pedro
- López Soledad
- López-Cortés Luis Fernando
- Machuca Isabel
- Macías Juan
- Malmierca Eduardo
- Martin Luisa
- Martinez Lorena
- Martinez Marina
- Martinez-Lacasa Javier
- Martinez-Romo Juan
- Martí Anna
- Martín Enrique
- Martín-Carbonero Ma Luz
- Martínez Clara
- Martínez Lourdes
- Martínez Mónica
- Martínez Onofre J.
- Martínez-Sanz Javier
- Masip Jenifer
- Masiá Mar
- Mayoral Mario
- Mellado María José
- Mena Álvaro
- Merino Esperanza
- Merlos M. Angustias
- Metola Luis
- Micán Rafael
- Miralles Celia
- Mirena Josu
- Montejano Rocío
- Montero Marta
- Montes María Luisa
- Morano Luis
- Moreno Ana
- Moreno Antonio
- Moreno Estela
- Moreno Santiago
- Moreno Victoria
- Muga Roberto
- Murillas Javier
- Muñoz Medina Leopoldo
- Muñoz Ángeles
- Navarro Vilasaro Marta
- Navarro Gemma
- Navarro Jordi
- Navarro Roser
- Novella María
- Novoa Cristina
- Núñez María José
- Ocampo Antonio
- Olalla Julián
- Olona Montserrat
- Omar Mohamed
- Orviz Eva
- Oteo José Antonio
- Padilla Belén
- Padilla Sergio
- Palacios Rosario
- Pascual José Francisco
- Pascual Rafael
- Pascual Reyes
- Pasquau Francisco
- Patiño Lucía
- Payeras Antoni
- Pelazas Ricardo
- Peraire Joaquín
- Pernas Berta
- Peñaranda María
- Pineda Juan Antonio
- Pinto Adriana
- Piérola Beatriz
- Planas Bibiana
- Polo Víctor
- Portilla Irene
- Portilla Joaquín
- Portilla Julia
- Pousada Guillermo
- Poveda Eva
- Prada José Luis
- Prieto Laura
- Puerta Teresa
- Pulido Federico
- Pérez Alexandre
- Pérez Desiré
- Pérez Ignacio
- Pérez Ignacio
- Pérez Javier
- Pérez Leire
- Pérez M. Jesús
- Pérez Verónica
- Pérez-Martínez Laura
- Pérez-Molina José Antonio
- Ramos Luis
- Ramírez Margarita
- Raposo Montserrat
- Real Luis Miguel
- Repáraz Jesús
- Reus Sergio
- Rial David
- Ribas M. Àngels
- Riera Melchor
- Rincón Pilar
- Rivas Carmenado María Eugenia
- Rivero Juárez Antonio
- Rivero Román Antonio
- Rivero María
- Robledano Catalina
- Roca Cristina
- Rodríguez Carmen
- Rodríguez Juan Carlos
- Rodríguez Lucía
- Rodés Berta
- Rubio Rafael
- Ruiz M. Pilar
- Ruiz-Sancho Andrés
- Rull Anna
- Ruíz Inma
- Sagastagoitia Iñigo
- Sainz Talía.
- Salavert Miguel
- Sampériz Gloria
- Sanchez Matilde
- Sanchez-de-Madariaga Ricardo
- Sanchiz Cruz Marta
- Sanmartí Montse
- Santacreu Mireia
- Santos Jesús
- Sanvisens Arantza
- Sanz Jesús
- Sanz José
- Sanz Mercedes
- Sanz Nieves
- Saumoy María
- Segarra Inmaculada
- Sendagorta Elena
- Serrano Sergio
- Silva Ana Karina
- Suanzes Paula
- Suarez-García Inés
- Suarez-Zarracina Tomás
- Sáez Carmen
- Sáez Elena
- Sánchez Guirao Antonio Jesús
- Sánchez M. José
- Sánchez-Cerrillo Ildefonso
- Sánchez-Payá José
- Tapia Elena
- Tasias María
- Tejerina Francisco
- Telenti Guillermo
- Telleria Pablo
- Tiraboschi Juan Manuel
- Tomás Cristina
- Torres Rafael
- Torrus Diego
- Universitat Autònoma de Barcelona
- Valencia Eulalia
- Vallejo Alejandro
- Vargas Montserrat
- Velli Pablo
- Vera Francisco Jesús
- Vera Mar
- Vergas García Jorge
- Viciana Isabel
- Vidal Asunción
- Vidal Francesc
- Viladés Consuelo
- Vilchez Helem H.
- Villa López M.
- Villalba M. Carmen
- Vinuesa David
- Vivancos M. Jesús
- Viñuela Laura
- von Wichmann Miguel Ángel
- Vázquez Pilar
- Xercavins Mariona
- Yeregui Elena
- Álvarez Beatriz
- Álvarez Marta
- Álvarez Patricia
- Álvarez-Rodriguez Ignacio
- Publication venue
- Publication date
- 01/01/2022
- Field of study
Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS-so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts
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Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study
- Author
- Ababneh Hazim
- Abad-Motos Ane
- Abbas Ferial Mohamed Ali
- Abbo Olivier
- Abbott Tom
- Abbott Tom
- Abdelkabir Mohammed
- Abdelkhalek Mohamed
- Abdoun Meriem
- Abdur-Rahman Lukman
- Abdur-Rahman Lukman
- Abebe Metasebia
- Aboazamazem Hajir
- Abou Chaar Mohamad K.
- Abou Chaar Mohamad K.
- Abouelnagah Galal
- Abozied Hesham
- Abu Salhiyeh Ala A.
- Abu-Ismail Luai
- Abu-Mehsen Marah
- Abuawad Carla
- Abukhalaf Sadi A.
- Abuleil Amro
- Ackermann Travis
- Acquah Daniel Kwesi
- Adam Mohammed Elmujtba Adam Essa
- Adamina Michel
- Adamina Michel
- Ademuyiwa Adesoji
- Adesanya Opeoluwa
- Adisa Adewale
- Adisa Adewale
- Afolabi Akinwale
- Agarwal Arnav
- Agarwal Gaurav
- Agarwal Ketan
- Agastra Ervis
- Agastra Ervis
- Agbadebo Mouhamed
- Agbonrofo Peter
- Aguilera-Arevalo Maria-Lorena
- Aguilera-Arevalo Maria-Lorena
- Ahmad Amer
- Ahmad Siddique
- Ahmadi Navid
- Ahmed Waheed-Ul-Rahman
- Aigner Felix
- Aiken Taylor
- Akhavizadegan Hamed
- Akhbari Melika
- Akililu Yemisirach Bizuneh
- Akinmade Akinola
- Al Ameer Ahmed
- Al Ameer Ahmed
- Al Amri Abdulrahman
- Al Balushi Zainab
- Al Islam Ben Jouira Rayet
- Al Maadany Faraj
- Al-Manaseer Balqees Mahmoud
- Al-Naggar Hamza
- Al-Naggar Hamza
- Al-Raimi Ibrahim
- Al-Sabbagh Yusra
- Al-Shehari Mohammed
- Aladawi Omar
- Alajalen Amer
- Alalawi Yousef
- AlAmeer Ehab
- Alameer Ehab
- Alansari Arowa Hassan Abdulrahman
- Alawami Mohammed
- Alawneh Yazan
- Alayan Mohammed
- Albared Sara Maa
- Albertsmeier Markus
- Albertsmeier Markus
- Alderazi Amer
- Aldlyami Ehab
- Aldressi Wafa
- Alecci Anna
- Alexander Philip
- AlFakhri Abdullah
- Alharthi Mohammed
- Alhassoun Turki
- Alhefdhi Amal
- Alkadeeki Ghadah
- Alkaseek Akram
- Alkhatib Ahmad
- Allemand Carola
- Almabayev Ydyrys
- Almeida-Reis Rui
- Almiqlash Bushray
- Almoguera Jorge
- Almugaddami Ayman
- Almulhim Abddulrahman Saleh
- Alnachoukati Omar
- Alnahr Hareth
- Alonso Jesús Aarón Martínez
- Alonso Manuel Diez
- Alonso Nestor Fabian Pedraza
- Alqudah Majdi Ali
- Alrayes Bourhan
- Alsaadi Hayder
- Alsaadi Hayder
- Alser Osaid
- Alshaar Muhammad
- Alshahrani Mushabab
- Alshareef Khayriyah
- Alshehri Ameen
- Alshryda Sattar
- Alshryda Sattar
- Alsibai Sareyah
- Alsunna Zaid
- Altaf Humera Naz
- Althumairi Azah
- Althumairi Azah
- Althumairi Azah
- Alvarado Carlos Eduardo Otiniano
- Alyami Mohammad
- Alzahrani Abdulrahman
- Alzaidi Turki M.
- Alzate Juan Pablo
- Alzerwi Nasser
- Amisi Nicolas
- Amnaina Mohamed
- Amor María Sol Crespi
- André Benoît
- Angeles Martina Aida
- Anwer Mariyah
- Anyanwu Lofty-John
- Aouabed Nesrine
- Aqeelah Ahmed
- Aqil Sabra
- Arancibia José Alfredo Calderón
- Arango Maria Clara Mendoza
- Arbane Gill
- Argus Leah
- Arias Claudia
- Arnalsteen Laurent
- Arnaud Alexis P.
- Arnaud Alexis P.
- Asif Muhammad
- Assefa Melatework
- Atnafu Bahru
- Aulerio Giuliana D.
- Aurora
- Awad Selmy
- Ayasra Faris
- Ayasra Faris
- Ayoub Abdu
- Ayub Bushra
- Ayub Khurram
- Azevedo José
- Azevedo José
- Azevedo Pedro
- Aziz Aliya
- Azzam Ahmed Y.
- Bacalbasa Nicolae
- Badareesh L.
- Badenes Rafael
- Badiani Sarit
- Baig Mariam
- Bains Lovenish
- Baiocchi Glauco
- Baiocchi Glauco
- Baiocchi Glauco
- Bajaj Ankur
- Balanta-Melo Julián
- Balasubramanya Supriya
- Bali Oussama
- Baliarsing Lipika
- Ball Alasdair
- Ballouhey Quentin
- Ban Vin Shen
- Bankhead-Kendall Brittany
- Bankhead-Kendall Brittany
- Barillas Sabrina
- Barker John
- Barros Aldo Vieira
- Basnayake Oshan
- Bastet Joaquin
- Basu Somprakas
- Bateman Antony
- Bath Michael
- Batista Sylvia
- Bauset Juan Carlos Catalá
- Bayo Heura Llaquet
- Baía Catarina
- Behzadi Abdollah
- Bekele Kebebe
- Bele Uros
- Bele Uros
- Bellver Pedro Palazon
- Ben Amer Anass
- Benallel Nassim
- Benson Ruth
- Berber Norberto
- Bergeat Damien
- Bergkvist David Julià
- Bernal-Sprekelsen Juan Carlos
- Berndtson Allison
- Bertrand Marta
- Bescós Coro
- Bezabih Yoseph Solomon
- Bhanderi Shivam
- Bhangu Aneel
- Bhangu Aneel
- Bhat Dhananjaya
- Bhatti Abu Bakar Hafeez
- Bhende Vishal
- Bhutiani Neal
- Bianco Agustín
- Biccard Bruce
- Blanco-Colino Ruth
- Blanco-Colino Ruth
- Blanco-Colino Ruth
- Blasco Laura Sánchez
- Boccalatte Luis
- Boccalatte Luis
- Boccalatte Luis
- Boira Mar Achalandabaso
- Boisson Matthieu
- Bolatbekova Raikhan
- Bolger Jarlath
- Bollano Enton
- Bonci Eduard-Alexandru
- Bonci Eduard-Alexandru
- Borda-Luque Giuliano
- Boretto Jorge G.
- Borges Filipe Castro
- Bork Ulrich
- Borowski David W.
- Botero Marcela Velez
- Bouaoud Souad
- Bouche Pierre-Alban
- Bouchenak Kamel
- Boucher Sophie
- Boudou Rocio
- Bouhuwaish Ahmad
- Brandariz Rodrigo
- Branquinho Rita
- Brar Amanpreet
- Brar Amanpreet
- Bravo Ana Maria Minaya
- Bravo Ana Maria Minaya
- Breen Kerry
- Brennan Caitlin
- Brien Stephen O.
- Bright Tim
- Brown Wendy
- Brunaud Laurent
- Brunner Stefan M.
- Buarque Igor Lima
- Bucyibaruta Georges
- Bukhari Syed Imran
- Buljubasich Martin
- Burchakchi Arturo
- Burgan Dania
- Busnelli Virginia Cano
- Buttaro Martin
- Butyrskii Aleksandr
- Bwala Kefas
- Bywater Edward P.
- C Ricci
- Caiado André
- Caicedo Lina
- Cal Fernando Bonilla
- Callcut Rachael
- Calvache Albaro José Nieto
- Calvache Jose Andres
- Calvache Jose Andres
- Calvache Jose Andres
- Calzaretta Laura Gisela Alvarez
- Campana Juan Pablo
- Campos Heloisa Galvão do Amaral
- Capitaine Daniel
- Cappeliez Serge
- Cardoso Paulo
- Carmichael Heather
- Carminatti Tomas
- Carrera Jacqueline
- Carreras-Castañer Anna
- Caruana Edward
- Cereghini Julian
- Cerovac Anis
- Cerovac Anis
- Chadi Sami
- Chakrabortee Sohini
- Chan Matthew
- Chandrasinghe Pramodh
- Chapatwala Reema
- Charbonneau Helene
- Charles Shane
- Chaudhary Muhammad Hamid
- Chaudhry Daoud
- Chaudhry Daoud
- Chaudhry Navneet Kumar
- Chauhan Govind Singh
- Chebaro Alexandre
- Chew Min Hoe
- Chin Theresa
- Chinyowa Simbarashe
- Chiuyari Jose Rios
- Choong Peter
- Chowdappa Raghunandan Gorantlu
- Chowdhury Sharfuddin
- Christensen Peter
- Chuan Alwin
- Chwat Carina
- Chwat Carina
- Clancy Cillian
- Coimbra Felipe José Fernandez
- Coleman Julia
- Colmenares Yahaira Tatiana Carpio
- Colás-Ruiz Enrique
- Connelly Tara
- Connor Clare O.
- Coonar Aman
- Corbett Harriet
- Corella Fernando
- Corripio-Sanchez Ramon
- Costa Luciana Cidade
- Costas-Chavarri Ainhoa
- Costea Radu
- Cotta Estefanía
- Cox Daniel
- Cox Daniel
- Creavin Ben
- Croattini Roberto Sebastián
- Croghan Stefanie M.
- Crétolle Célia
- Cukier Moises
- Cukier Moises
- Cullinane Carolyn
- Cunha Miguel F.
- Cunha Miguel F.
- Dajti Irida
- Dajti Irida
- Dajti Irida
- Daoud Hassan
- Das Rishi
- Davies-Jones Gareth
- Davis Niall
- Dawson Amanda Caroline
- Dawson Amanda Caroline
- Dawson Brett E.
- Dbeis Rachel
- De Andrés-Asenjo Beatriz
- De Cortazar Unai Garcia
- de Dieu Haragirimana Jean
- de León Laura Román García
- De Simone Belinda
- Dean Benjamin
- Degefa Eyueal
- Del Pilar Paucar Urbina Arazzelly
- Delibegovic Samir
- Delisau-Puig Olga
- Dell Angela
- Demetrashvili Zaza
- Demetrashvili Zaza
- Demetriades Andreas K.
- Derilo Habtamu
- Desai Anant
- Deus Ana Cláudia
- Dharap Satish
- Dhondt Bert
- Dhufera Hailu
- Di Martino Marcello
- Di Saverio Salomone
- Di Vincenzo Marcela
- Diaz-Couselo Fernando
- Diehl Thomas
- Dimofte Mihail-Gabriel
- DiNome Maggie
- Djahida Bahraoui
- Doerner Johannes
- Domenech Julio
- Donlon Noel
- Drake Frederick
- Drake Thomas
- Drasovean Radu
- Duarte Amalia Barrios
- Duarte Carolina Lugo
- Dube Surya Kumar
- Duchalais Emilie
- Dudi-Venkata Nagendra
- Duran Irani
- Duric Natalie
- Duro Agustin
- Dwaga Sumayya Essayah
- Dziakova Jana
- Déserts Marc Danguy des
- Díaz-Feijoo Berta
- Earley Helen
- Eberbach Helge
- Edwards John
- Edwards John
- Efetov Sergey
- Efetov Sergey
- Egoroff Natasha
- Eiras Miguel Angel Freiria
- Ekenze Sebastian
- El Helw Amin
- El Kafsi Jihène
- El-Boghdadly Kariem
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- Zmora Oded
- Zmora Oded
- Zohra Belabbes Fatima
- Publication venue
- HAL CCSD
- Publication date
- 01/11/2021
- Field of study
We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care
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
- 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
- Alemdag 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
- Arora Deeksha
- Arowolo Olukayode
- Arrangoiz Rodrigo
- Arslan Ekin
- Artigau Eva
- Ashfaq Ahsan
- Ashour Dina
- Ashour Firas
- Ashoushan Hana
- Ashraf Ahmed
- Ashraf Alaa
- Asif Ashar
- Asnel Dorisme
- Asok Anjitha
- Assa Rawan
- 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
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- 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
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- Bani hani Zeina
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- Banks Alexander
- Bannister Sharon
- Baranyai Zsolt
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- Baronio Gianluca
- Barreda Zelaya Lilian Elizabeth
- Barrera López Francisco Javier
- Barsic Neven
- Barter Charlotte
- Bartosiak Katarzyna
- Basarab Maksym
- Basso Stefano Maria Massimiliano.
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- Batashki Ilia
- Bath Michael
- Beattie Miriam
- Bedada Alemayehu Ginbo
- Belais Fanny
- Belal qadomi Asef
- Belev Nikolay
- Belli Andrea
- Beltrán de Heredia Juan
- Belvedere Angela
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- Benkabbou Amine
- Benke Marton
- Benyaiche Chaymae
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- Bernstein Mitchell
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- Beuran Mircea
- Bhandare Manish
- Bhangu Aneel
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- Bianchini Stefania
- Bianco Francesco
- Bibas Fatma
- Biccard Bruce M
- Bielosludtsev Oleksii
- Bienfait Mumbere
- Billy Matthew
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- C S Archana
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- Castilla Moreno Miguel Angel
- Castillo Arrascue José Neiser
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- Castro Ernes John
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- Clements Joshua Michael
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- Cocorullo Gianfranco
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- Doe Matthew
- Dogruoz Alper
- Doherty Ronan J
- Dollie Qaasim
- Dominguez Genieve
- Dominguez Joaquina
- Domini Edgar
- Dossou Francis
- Dousset Bertrand
- Draganic Brian
- Drake Thomas M
- Drane Andrew
- Duarte Marina
- Dudi-Venkata Nagendra Naidu
- Duggan William
- Duke Kathryn
- Duller Alexander
- Dulskas Audrius
- Dumitra Sinziana
- Dural Ahmet Cem
- Dworak Jadwiga
- Dzhumabaev Khasan
- Dziedzic Jacek
- Díaz Vico Tamara
- Eaazim Jose
- Eardley Nicola
- Echeverria-Davila Guillermo
- Edirisooriya Monisha
- Eerola Verner
- Eid Esraa
- Eismontas Vitalijus
- Eklöv Karolina
- Ekpete Ogbonnia
- Ekwen Gerald
- 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
- Eray Ismail Cem
- Erkul Oguz
- Esbaga Fatima
- Escobar Dennis
- Escrevente Ricardo
- Eskander John
- Eslam Sara
- Esmat Nourhan Ahmed
- Esper Asil
- Espin-Basany Eloy
- Espina Perez Beatriz
- Espinosa-Bravo Martin
- Esposito Giovanni
- Essam Ibrahim El Desouki Muhammad Ahmed Muhammad
- Essam Eman
- Estalagem Inês
- Estevez Tesouro José
- Eswaye Haitem
- Etchill Eric
- Etonyeaku Amarachukwu
- Eusebio Zegarra Ivan Edward
- Ezzat Helmy
- Fadel Ahmed
- Fahira Alessa
- Fahmawee Toqa
- Fairfield Cameron J
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- NA N.A.
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- Zabiyaka Mikhail
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- Zafar Syed Nabeel
- Zaffaroni Gloria
- Zahra Baryab
- Zahran Diaaaldin
- Zakaria Andee Dzulkarnaen
- Zakaria Mai
- Zakaria Omar
- Zakaria Zaidi
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- Zammit Matthew
- Zanini Nicola
- Zara Vlu Jean
- 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
- 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
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- Wondoh Paul M.
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- Yenli Edwin
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- Yeoh Andrea
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- Yeşilsancak Merve
- Yildirim Reyyan
- Yildiz Alp
- Yilmaz Duygu
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- Yong Shun Qi
- Yoong Andrel
- Yorke Joseph
- Yotsov Tsanko
- You Lucia
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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