Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Percepção de saúde e fatores associados em industriários de Santa Catarina, Brasil Self-perceived health and associated factors in industrial workers from Santa Catarina State, Brazil

O objetivo foi identificar a prevalência e os fatores associados à percepção negativa de saúde em trabalhadores da indústria no Estado de Santa Catarina, Brasil. Para tanto, foi realizado estudo transversal em amostra representativa de 2.574 sujeitos (62,5% - homens). A percepção negativa de saúde foi o desfecho investigado em relação a variáveis demográficas, sócio-econômicas, perceptivas (estresse e sono) e de saúde. Análise de regressão logística multivariável não condicional baseada em modelo hierárquico foi utilizada para explorar associações. A percepção negativa de saúde foi baixa (11,8%) e positivamente associada com a faixa etária, atividade física de lazer, percepção da qualidade do sono, percepção do estresse e sexo. Em contrapartida, a renda familiar bruta e o nível de escolaridade associaram-se inversamente ao desfecho. Industriários que exerciam trabalhos de maior demanda física e aqueles classificados nos extremos das categorias do índice de massa corporal (< 18,5kg/m² ou >30kg/m²) apresentaram maiores prevalências de percepção negativa de saúde. Diferenças significativas de acordo com o estado civil, consumo de bebidas alcoólicas (binge drinking) e tabagismo não foram verificadas. Poucas associações foram reveladas para o sexo feminino.<br>The purpose of this study was to determine the prevalence of negative self-perceived health and associated factors among industrial workers in Santa Catarina State, in southern Brazil. A cross-sectional investigation was conducted with a representative sample of 2,574 subjects (62.5% men). Negative self-perceived health (fair or poor) was the outcome investigated in association with demographic, socioeconomic, and other health indicators. Multivariate analysis was performed through logistic regression based on a hierarchical model. Negative self-perceived health was exceptional (11.8%), but positively associated with age, leisure physical activity, perceived quality of sleeping, perceived stress, and sex. Meanwhile, the outcome was negatively associated with family income and schooling. Workers with higher physical demands and BMI < 18.5 and > 30 showed increased odds of negative self-perceived health. No significant differences were found for marital status, binge drinking, or smoking. Few associations were observed for females