Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

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

pupil-labs/pupil: Pupil Capture, Player, and Service release

We are pleased to announce the release of Pupil v1.10! Download the latest bundle and let us know what you think via the #pupil channel on Discord :smile: Features Capture RealSense D400 Support - #1409 Please be aware, that it is recommended to keep your D400's firmware update-to-date. See the Intel documentation on how to do that. Intel does not currently provide a Python wrapper for macOS. Until they do, we are not able to support the Pupil Capture D400 backend on macOS. Player Export timestamps as csv on video export Timestamps will now be exported as a csv when you export a video #1411 Command-line arguments - #1384 Previously, only simple arguments could be passed to Pupil via command-line. This included the debug and profiled mode. Motivated by #1315, we decided to start parsing command-line arguments properly. See the pull request description for details on the available command-line arguments. Pupil Remote port command-line argument Using the --port PORT argument, it is now possible to set the Pupil Remote port for Capture and Service. Bugfixes Fake Backend: Fix playback after seeking - #1396 Fixation Detector: Fix export format - #1395 Improved compatibility with macOS 10.14 Mojave - #1381 Developers notes New dependencies Optional, required for RealSense D400 backend: pyrealsense2 API changes Pupil Detector Network API, see PR for details - #1395 Pupil Remote: Forward IPC/multipart messages - #1385 We are hiring Python developers! Hey - you're reading the developer notes, so this is for you! We're looking to hire developers to contribute to Pupil source code. If you love Python and enjoy writing code that is a joy to read, get in touch. Experience with the scientific Python stack is a plus, but not required. We have a lot of exciting projects in the pipeline. We are also looking for full stack Python developers that have experience with kubernetes, docker, and async server-side Python. Send an email to [email protected] with a CV to start a discussion. We look forward to hearing from you.We are pleased to announce the release of Pupil v1.10! Download the latest bundle and let us know what you think via the #pupil channel on Discord :smile: Features Capture RealSense D400 Support - #1409 Please be aware, that it is recommended to keep your D400's firmware update-to-date. See the Intel documentation on how to do that. Intel does not currently provide a Python wrapper for macOS. Until they do, we are not able to support the Pupil Capture D400 backend on macOS. Player Export timestamps as csv on video export Timestamps will now be exported as a csv when you export a video #1411 Command-line arguments - #1384 Previously, only simple arguments could be passed to Pupil via command-line. This included the debug and profiled mode. Motivated by #1315, we decided to start parsing command-line arguments properly. See the pull request description for details on the available command-line arguments. Pupil Remote port command-line argument Using the --port PORT argument, it is now possible to set the Pupil Remote port for Capture and Service. Bugfixes Fake Backend: Fix playback after seeking - #1396 Fixation Detector: Fix export format - #1395 Improved compatibility with macOS 10.14 Mojave - #1381 Developers notes New dependencies Optional, required for RealSense D400 backend: pyrealsense2 API changes Pupil Detector Network API, see PR for details - #1395 Pupil Remote: Forward IPC/multipart messages - #1385 We are hiring Python developers! Hey - you're reading the developer notes, so this is for you! We're looking to hire developers to contribute to Pupil source code. If you love Python and enjoy writing code that is a joy to read, get in touch. Experience with the scientific Python stack is a plus, but not required. We have a lot of exciting projects in the pipeline. We are also looking for full stack Python developers that have experience with kubernetes, docker, and async server-side Python. Send an email to [email protected] with a CV to start a discussion. We look forward to hearing from you.1.1