9 research outputs found
DESIGN AND IMPLEMENTING A HEAT PIPE EXPPERIMANTAL SYSTEM FOR RESIDENTIAL HEATING
- Publication venue
- University of Baghdad
- Publication date
- 01/12/2007
- Field of study
The design and construction of an instrumented heat pipe H.P for domestic heating that uses water as a working fluid was undertaken to investigate experimentally the performance of the H.P under various operating conditions of: Power levels, water inventories and angle of inclinations. A theoretical model to predict the temperature of the condenser surface (the temperature at which heat is rejected) and system pressure at steady state conditions was developed and used to compare these parameters with the experimental findings. The model utilizes the total heat supplied to the evaporator to predict system pressure and condenser temperature. The theoretical model is suitable for vertical H.P (i.e. =0) and its predictions of condenser surface temperature is within 16% and of system pressure is within 21%. An acceptable H.P design may have a condenser heat flux of 1.16 k W/m2 with a corresponding system pressure of 1500 kPa
Columnar Metaplasia of the Esophagus Presenting as Iron Deficiency Anemia in Children with Neurologic Impairment or Congenital Esophageal Atresia
- Publication venue
- DigitalCommons@TMC
- Publication date
- 13/10/2022
- Field of study
BACKGROUND Columnar metaplasia of the lower esophagus includes both gastric and intestinal metaplasia. Children with severe neurologic impairment and congenital esophageal atresia often have gastroesophageal reflux disease, which can lead to Barrett\u27s esophagus, a form of lower esophageal columnar metaplasia and precursor to esophageal adenocarcinoma, with some, but not all, guidelines specifically requiring the presence of intestinal metaplasia for diagnosis. This case series illustrates how iron deficiency anemia may be the primary symptom of esophageal columnar metaplasia in such children and how upper endoscopy is essential in their initial and ongoing evaluation. CASE REPORT We review 5 cases of columnar metaplasia of the lower esophagus in children, 3 with severe neurologic impairment and 2 with esophageal atresia. Each child presented with marked iron deficiency anemia and minimal-to-no gastrointestinal symptoms. CONCLUSIONS We conclude that columnar metaplasia of the esophagus may present with iron deficiency anemia in children with neurologic impairment or congenital esophageal atresia, even if without overt gastrointestinal symptoms. Accordingly, we propose that early endoscopic evaluation should be considered in this specific patient population. Based on our literature review, we also emphasize the need for guidelines on the endoscopic surveillance of such children with any type of columnar metaplasia of the lower esophagus, given the associated risk of malignant transformation
Probiotic-Derived Ecto-5\u27-Nucleotidase Produces Anti-Inflammatory Adenosine Metabolites in Treg-Deficient Scurfy Mice
- Author
- Publication venue
- DigitalCommons@TMC
- Publication date
- 01/08/2023
- Field of study
Probiotic Limosilactobacillus reuteri DSM 17938 (DSM 17938) prolongs the survival of Treg-deficient scurfy (SF) mice and reduces multiorgan inflammation by a process requiring adenosine receptor 2A (A2A) on T cells. We hypothesized that L. reuteri-derived ecto-5’-nucleotidase (ecto-5’NT) activity acts to generate adenosine, which may be a central mediator for L. reuteri protection in SF mice. We evaluated DSM 17938–5’NT activity and the associated adenosine and inosine levels in plasma, gut, and liver of SF mice. We examined orally fed DSM 17938, DSM 17938Δ5NT (with a deleted 5’NT gene), and DSM 32846 (BG-R46) (a naturally selected strain derived from DSM 17938). Results showed that DSM 17938 and BG-R46 produced adenosine while “exhausting” AMP, whereas DSM 17938∆5NT did not generate adenosine in culture. Plasma 5’NT activity was increased by DSM 17938 or BG-R46, but not by DSM 17938Δ5NT in SF mice. BG-R46 increased both adenosine and inosine levels in the cecum of SF mice. DSM 17938 increased adenosine levels, whereas BG-R46 increased inosine levels in the liver. DSM 17938Δ5NT did not significantly change the levels of adenosine or inosine in the GI tract or the liver of SF mice. Although regulatory CD73+CD8+ T cells were decreased in spleen and blood of SF mice, these regulatory T cells could be increased by orally feeding DSM 17938 or BG-R46, but not DSM 17938Δ5NT. In conclusion, probiotic-5’NT may be a central mediator of DSM 17938 protection against autoimmunity. Optimal 5’NT activity from various probiotic strains could be beneficial in treating Treg-associated immune disorders in humans
Environmentally Specific Servant Leadership and Brand Citizenship Behavior: The Role of Green-Crafting Behavior and Employee-Perceived Meaningful Work
- Author
- Publication venue
- 'MDPI AG'
- Publication date
- 01/06/2023
- Field of study
Sustainability and environmental concerns have become increasingly important in the business world, with organizations seeking to integrate sustainable practices and enhance their brand citizenship behavior. Servant leadership that is focused on the environment is a type of leadership approach that gives prominence to preserving and promoting environmental sustainability. This study aims to examine the impact of environmentally specific servant leadership on brand citizenship behavior, with a focus on the mediating roles of green-crafting behavior and employee-identified meaningful work. Drawing on data from a survey of 319 employees working in hotels, this study conducted partial least square–structural equation modeling (PLS-SEM) to test a dual-moderated mediation model to explore the direct and indirect effects of environmentally specific servant leadership on brand citizenship behavior. The results of this study reveal that environmentally specific servant leadership has a significant and positive impact on green-crafting behavior and employee meaningful work. Moreover, green-crafting behavior and employee-perceived meaningful work both mediate the link between environmentally specific servant leadership and brand citizenship behavior. Specifically, green-crafting behavior acts as a mediator between environmentally specific servant leadership and employee-perceived meaningful work, while employee-perceived meaningful work mediates the link between green-crafting behavior and brand citizenship behavior. These findings have important implications for managers and organizations that seek to enhance their sustainability and brand citizenship behavior. Specifically, this study highlights the critical role of environmentally specific servant leadership (ESSL) in promoting green-crafting behavior and employee-perceived meaningful work, which in turn influence brand citizenship behavior. Therefore, organizations can improve their brand citizenship performance by developing ESSL behaviors and practices that foster green-crafting behavior and employee-perceived meaningful work
Effect of clonidine versus dexmedetomidine on pain control after laparoscopic gastric sleeve: A prospective, randomized, double-blinded study
- Author
- Publication venue
- Wolters Kluwer Medknow Publications
- Publication date
- 01/01/2014
- Field of study
Background: The use of opioids in surgeries for morbidly obese patients could cause respiratory depression. Therefore, alternative analgesics are needed to improve anesthetic management for obese patients. The objective of this study was to compare the effect of dexmedetomidine and clonidine on pain as well as analgesic consumption at 24 h postoperatively in patients undergoing laparoscopic gastric sleeve. The secondary objective was to compare patients′ and surgeons′ satisfaction. Materials and Methods: A total of 60 obese and morbidly obese patients scheduled to undergo laparoscopic gastric sleeve were randomly assigned into two groups. 10 min after induction of general anesthesia, one group received 0.8-1.2 μg/kg/30 min intravenous (IV) clonidine through 500 mL lactated Ringer′s solution and placebo (normal saline solution) through syringe pump. The second group received IV dexmedetomidine through syringe pump at a rate 0.5-0.8 μg/kg/h and placebo through 500 mL lactated Ringer′s solution. Data on pain, analgesic consumption, and return to normal activity in addition to patients′ and surgeons′ satisfaction were collected. Results: Both groups were similar with respect to demographic and intraoperative hemodynamic characteristics. Fentanyl consumption, surgery duration and hospital stay were similar for the two groups. Pain scores on walking were significantly lower in the clonidine group at 12 h postoperatively (P = 0.014) compared with dexmedetomidine group. The number of patients who consumed pethidine was significantly lower in the clonidine group at 12 h postoperatively (P = 0.045). Conclusion: This study concluded that clonidine and dexmedetomidine yielded similar outcomes with a difference in pain and analgesic consumption at 12 h postoperatively
PulseNet Lebanon: An Overview of Its Activities, Outbreak Investigations, and Challenges
- Author
- Publication venue
- 'Mary Ann Liebert Inc'
- Publication date
- Field of study
SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
- Author
- Aamir Junaid
- Abaalkhail Muath
- Ababneh Adnan
- Ababneh Hazim
- Ababneh Laila
- Ababneh Roba
- Abad-Motos Ane
- Abaker Mussab
- Abary Ryan
- Abass Adam
- Abate Emmanuele
- Abayomi Olukayode
- Abazeed Alaa
- Abbad Bader
- Abbadessa Francesco
- Abbadi Osaid
- Abbakar Malaz
- Abbas Ahmed
- Abbas Alzhraa
- Abbas Asad
- Abbas Aya
- Abbas Jihad
- Abbas Manzar
- Abbas Mohammad
- Abbas Omer
- Abbasov Aykhan
- Abbo Olivier
- Abbott Daniel
- Abbott Tom
- Abboud Omar
- Abd Waleed
- Abd-Elkariem Ahmed
- Abd-Elsalam Sherief
- Abdalah Ahmad
- Abdalhadi Alya
- Abdalla Ahmed
- Abdalla Eman
- Abdalla Samir
- Abdalla Shimaa
- Abdalla Siddig
- Abdallah Emne
- Abdallah Ghaida
- Abdallah Lubna
- Abdallah Munir
- Abdallah Murad Al
- Abdallah Rasha
- Abdalnour Hani
- Abdeen Bashar
- Abdeewi Saedah
- Abdeh Louai
- Abdel-Aleem Mahmoud
- Abdel-Elsalam Wafaa
- Abdel-Fattah Areej
- Abdel-Fattah Nour
- Abdel-Hafez Ibrahim
- Abdelaal Abdelrahman
- Abdelaty Ahmed Adel
- Abdelazeem Khaled
- Abdelaziz Areej
- Abdelaziz Mohammed
- Abdelbagi Mohamad
- Abdelbaset Abouelnour
- Abdeldayem Hesham
- Abdelfattah Mahmoud
- Abdelgadir Alwaleed
- Abdelgalel Khaled
- Abdelghafar Moslem
- Abdelhafez Mohammed
- Abdeljalil Abdelkarim
- Abdelkabir Mohammed
- Abdelkareem Mohamed
- Abdelkarem Mohamed
- Abdelkarim Mostafa
- Abdelkhalek Mohamed
- Abdellah Fatima
- Abdelmajeed Ahmed
- Abdelmalik Abubaker
- Abdelmawla Ahmed
- Abdelrahman Abdelrahman
- Abdelrahman Haneen
- Abdelraouf Ali
- Abdelsamed Ahmed
- Abdelwahab Omar
- Abderrazaq Hafni
- Abdissa Desalegn
- Abdo Adnan Sayid
- Abdou Hossam
- Abdou Mostafa
- Abdoun Meriem
- Abdow Mohammad
- Abdrabou Ahmed
- Abdualqader Mahmmoud
- Abdul-Jabar Hani
- Abdul-Mumin Alhassan
- Abdulaal Safaa
- Abdulateef Omar
- Abdulfattah Ammar Yasser
- Abdulkareem Amal
- Abdull Mohammed
- Abdullaev Abakar
- Abdullah Abdullah
- Abdullah Bahiyah
- Abdullah Duha Milad
- Abdullah Muhammad Tariq
- Abdullah Nabila
- Abdullah Saleha
- Abdullah Shahbaz
- Abdullaha Lamess
- Abdullahi Alhassan
- Abdullahi Habiba
- Abdullahi Lawal
- Abdullahi Mohammed Kabir
- Abdullahi Sani
- Abdullahi Yasir Younis
- Abdulmalek Abdulmalek
- Abdulmalik Abdulmuez
- Abdulmohsen Ahmed
- Abdulqawi Nabil
- Abdulrahem Abdullah
- Abdulrahman Mamuda
- Abdulrahman Mohamed
- Abdulrahman Taha
- Abdulsalam Albaraa
- Abdulsalam Fareed
- Abdulsalam Khalifa
- Abdulsalam Moruf
- Abdulwahab Taiceer
- Abdulwahed Eman
- Abdunabi Murad
- Abdur-Rahman Lukman
- Abdurab Ebrahim
- Abdurehman Oumer
- Abdurrazzaaq Abdussemee
- Abdus-Salam Rukiyat
- Abdussalam Hameedat Opeyemi
- Abe Anthonia
- Abe Nobutsugu
- Abe Tatsuro
- Abebe Engida
- Abebe Kirubel
- Abebe Metasebia
- Abebe Nebyou
- Abebrese John Tabiri
- Abed Arsan Abu
- Abed Francisco
- Abed Haneen
- Abed Laith Abu
- Abedalqader Lina
- Abedin Yasmin
- Abel Joel Reuben
- Abel Livingston
- Abel Mary Kathryn
- Abelevich Alexander
- Abella Andrei Cesar
- Abichou Wijden
- Abid Rubaba
- Abiodun Adekunle
- Abiola Olajide
- Abiola Paul
- Abiyere Henry
- Aboalsamh Ghaleb
- Aboazamazem Hajir
- Abodeeb Aya
- Aboelkhel Roger
- Abojeila Farah
- Abosamak Nour Eldin
- Abosnaina Yahya
- Abostate Ahmed
- Abou-Abbass Hussein
- Abou-Khalil Jad
- Abouassi Layth
- Abouassi Majd
- Aboubakr Samar
- Aboubeirah Mohammed
- Abouelazayem Mohamed
- Abouelnagah Galal
- Abouelnagah Yossof
- Aboutaleb Shereen
- Aboutrab Ayham
- Abouzid Amr
- Abozied Hesham
- Abraham Bejoy
- Abrahams Jenevive
- Abramowicz Shelly
- Abrate Alberto
- Abreha Tassew
- Abrha Teklebirhan
- Abu-Arish Hamdoon
- Abu-Eisheh Basil
- Abu-Ishkerih Nizar
- Abu-Ismail Luai
- Abu-Libdeh Tareq
- Abu-Mehsen Marah
- Abu-Zaid Ahmed
- Abualteen Faisal
- Abuawad Carla
- Abubakar Abdullah
- Abubakar Ahmed
- Abubakar Mohammed Kabir
- Abubakr Abubakr
- Abubakr Asmaa
- Abubeih Hossam
- Abud Burçin
- Abudari Hadeel
- Abudher Abdulhafid
- Abuhamour Ehab
- Abuissa Khatab
- Abukhadra Mahmoud
- Abukhalaf Sadi A
- Abukhater Muhammad
- Abulafia Daniel
- Abuleil Amro
- Abulshuwashi Nayrouz Abdullah
- Abumahara Saleh
- Abunawas Huthifa
- Aburahmah Mohammad
- Aburayyan Fatima
- Aburima Sarah
- Abusabeib Abdelrahman
- Abusadah Samer
- Abusalem Marwa
- Abusannoga Malek
- Abushahma Ahmed Omar
- Abutaka Ahmad
- Abutaleb Malak
- Abuzaina Khalil
- Acatrinei Eduard
- Accarino Giulio
- Accorsi Guilherme
- Acharya Hriday
- Acharya Metesh
- Acharya Shivanie
- Achimas-Cadariu Patriciu
- Ackermann Travis
- Acosta Jesus
- Acosta Maria
- Acosta Yancy
- Acosta Úrsula
- Acquaye Jane
- Acra-Tolari Ricardo
- Acuña Gastón
- Adam John
- Adamala Soujanya
- Adamina Michel
- Adamoli Laura
- Adams Katie
- Adapa Akshath
- Addas Bassam
- Adebajo Emmanuel
- Adebanjo Ademola
- Adebara Idowu
- Adebayo Olaolu
- Adebayo Sikiru A
- Adeboyejo Oluwaseun
- Adegbola Samuel
- Adel Dina
- Adelaja Aderinsola
- Adeleye Amos
- Adeli Seyyed Hassan
- Adem Ephrem
- Ademola Samuel
- Ademuyiwa Adesoji
- Adeniran Abimbola
- Adeniran Abiodun
- Adeniyi Adebayo
- Adenwalla Mehjabeen
- Aderogba Adeleke Akeem
- Aderounmu Adewale
- Adesanya Opeoluwa
- Adesina Oluwaseyi
- Adesola Muideen
- Adeyemo Olabisi
- Adeyeye Ademola
- Adham Ibrahim
- Adi Hussam
- Adiamah Alfred
- Adikaibe Valentine
- Adil Md Tanveer
- Adisa Adewale
- Aditianingsih Dita
- Adjeso Theophilus
- Adlan Alsafe
- Adler Tina
- Admasu Azarias
- Adofo-Asamoah Yvonne
- Adrees Mohammed
- Adrianzén Marcos
- Adu-Aryee Nii Armah
- Aduse-Poku Maame
- Advani Rajeev
- Adze Joel
- Aeed Majed
- Afaque Syed Nayyar
- Afifi Amgad
- Afifi Eman
- Afifi Nermeen
- Afify Abdelrahman
- Afolabi Abdulrahman O
- Afolabi Akinwale
- Afolabi Bosede
- Afshar Salim
- Aftab Raiyyan
- Afuwape Oludolapo
- Afzal Ameer
- Afzal Maimoona
- Afzal Mohamed
- Afzal Muhammad Farooq
- Afzal Sadia
- Agalianos Christos
- Agapov Mikhail
- Agarwal Anjoo
- Agarwal Arnav
- Agarwal Gaurav
- Agarwal Ketan
- Agarwal Sunny
- Agarwal Varun
- Agastra Ervis
- Agbadebo Mouhamed
- Agbaje Ademola
- Agbedinu Kwabena
- Agbeko Anita Eseenam
- Agbeno Evans Kofi
- Agboadoh Nelson
- Agbonrofo Peter
- Ageeli Mohammed
- Aggarwal Gaurav
- Aggarwal Manisha
- Aggarwal Sonali
- Aghababyan Kristina
- Aghadi Ifeanyi
- Aghalarov Ilgar
- Aghamaliyev Ughur
- Aghayeva Afag
- Aghazadeh Kayvan
- Agida Eyaofun
- Agnes Annamaria
- Agnes Salvatore
- Agoncillo Anika Johanna
- Agossou Hermann
- Agrawal Amit
- Agrawal Mansi
- Agrawal Rachit
- Agrawal Sanjit Kumar
- Agrawal Tulika
- Agro Felice Eugenio
- Aguado Héctor J
- Aguayo Omar
- Aguilar Ana
- Aguilar Ruben
- Aguilera-Arevalo Maria-Lorena
- Aguinagalde Borja
- Aguirre Asier
- Aguzzoli Lorenzo
- Agyapong Meshach Manu
- Agyei Fareeda
- Agyeman-Duah Nana Kwaku
- Agyemang-Prempeh Akosua
- Agyen Thomas
- Ahamed Waseem
- Ahangari Roghayyeh
- Aherne Thomas
- Ahlaou Hamza
- Ahluwalia Saravpreet
- Ahmad Afaf
- Ahmad Ahmad Mustafa
- Ahmad Aline
- Ahmad Amer
- Ahmad Ashfaq
- Ahmad Aya
- Ahmad Basel
- Ahmad Fateen
- Ahmad Jameel Ismail
- Ahmad Maleeha
- Ahmad Manzoor
- Ahmad Misbahu
- Ahmad Mohamad
- Ahmad Muzaffar Ahmad
- Ahmad Niarah
- Ahmad Qamar Ashfaq
- Ahmad Quazi
- Ahmad Reyaz
- Ahmad Rofida
- Ahmad Saad Bilal
- Ahmad Shabir
- Ahmad Shahrukh
- Ahmad Sheraz
- Ahmad Siddique
- Ahmad Tareq
- Ahmad Zeeshan
- Ahmadi Navid
- Ahmadi Sayedali
- Ahmadvand Ali
- Ahmed Abdelkareem
- Ahmed Abdullah
- Ahmed Abedelrahman
- Ahmed Ahme
- Ahmed Aishah
- Ahmed Aminat Olayinka
- Ahmed Arooj
- Ahmed Ayman
- Ahmed Azaz
- Ahmed Ehsan
- Ahmed Faazil
- Ahmed Faryal
- Ahmed Ghazia
- Ahmed Haseeb
- Ahmed Hassaan
- Ahmed Idrees
- Ahmed Iffat
- Ahmed Irshad
- Ahmed Islam
- Ahmed Jawad
- Ahmed Kaleem
- Ahmed Khalid
- Ahmed Maira
- Ahmed Malik Shakeel
- Ahmed Manhal
- Ahmed Mariam
- Ahmed Moaiad Eldin
- Ahmed Mohamme
- Ahmed Muhammed
- Ahmed Nasir
- Ahmed Nauman
- Ahmed Omar
- Ahmed Safia
- Ahmed Sara
- Ahmed Shahnoor
- Ahmed Shakil
- Ahmed Sheraz
- Ahmed Waheed-Ul-Rahman
- Ahmed Waqas
- Ahmed Zubair
- Ahmedin Mahlet
- Ahsan Kunwar Armash
- Ahseen Naeimah
- Ahtash Abdurahman
- Aidarov Askar
- Aigner Felix
- Aiken Taylor
- Ailabouni Ramez
- Aimé Adeline
- Aiolfi Alberto
- Airoldi Angelo
- Aisuodionoe-Shadrach Oseremen
- Aitken Jake
- Aizza Giada
- Ajab Shereen
- Ajagha Okeoghene
- Ajai Olalekan
- Ajaj Hatem
- Ajami Dany
- Ajao Akinlabi
- Ajayi Adekunle
- Ajayi Peter
- Ajcip Gaby
- Ajekwu Samuel
- Ajekwu Temitope
- Aji Narjiss
- Aji Sani Ali
- Ajibola Hafees
- Ajiboye Olalekan
- Ajlan Abdulrazag
- Ajmi Ghadeer Al
- Ajmi Khalil Al
- Ajomah Nadia
- Akaba Godwin
- Akadh Ali
- Akalin Murat
- Akani Chris
- Akanni Bolaji
- Akbar Ali
- Akbar Bilal
- Akbar Hazrat Akbar
- Akbari Amir Ali
- Akbas Ahmet
- Akdeniz Yesim
- Akeel Nouf
- Akgor Utku
- Akhavizadegan Hamed
- Akhbari Melika
- Akhtar Amina
- Akhtar Fahad
- Akhtar Muhammad Adeel
- Akhtar Muhammad Shaheer
- Akhtar Munazza
- Akhtar Naseem
- Akhtar Tasleem
- Akhund Ramsha
- Akiely Jehad
- Akililu Yemisirach Bizuneh
- Akin Emrah
- Akinajo Opeyemi
- Akindoyin Success
- Akinloa Olufemi
- Akinmade Akinola
- Akinsola Sanusi
- Akinyemi Tosin
- Akkour Khalid
- Akl Michel
- Aklilu Abenezer Tirsit
- Akmercan Ahmet
- Akpla Marcellin
- Akpoghor Oghenevwegba
- Akram Shahzad
- Aktaa Nazeeh Al
- Akthar Farah
- Aktimur Yunus Emre
- Akulaev Anton
- Akyol Cihangir
- Akça Oktay
- Akçay Mertcan
- Al Aggeliki
- Al Aya Abdul
- Al-Abri Rashid
- Al-Absi Emad
- Al-Adwan Sofian
- Al-Ameri Saba
- Al-Atiyah Hussam
- Al-Azzawi Marwa
- Al-Badawi Ismail
- Al-Balas Hasan
- Al-Dabaa Tawfik
- Al-Darabah Ali
- Al-Dhaheri Awsan
- Al-Dolat Wedad
- Al-Embideen Somya
- Al-Eryani Fatima
- Al-Garadi Abdulrahman Faisal
- Al-Gilani Maha
- Al-Habib Amro
- Al-Hasani Fahad
- Al-Hebbah Amer
- Al-Houssami Salma
- Al-Howthi Mohammed
- Al-Isawi Ali
- Al-Jadaan Mohammad
- Al-Jarrah Amar
- Al-Jarrah Hothaifa
- Al-Jarrah Salsabeel
- Al-Kasaji Farah
- Al-Khaddar Ziad
- Al-Latayfeh Motasem
- Al-Madhrahi Ahmed
- Al-Maghrabi Sanabel
- Al-Mahdi Shehab
- Al-Mahmeed Husain
- Al-Manaseer Balqees Mahmoud
- Al-Mandeel Hazem
- Al-Maqtari Sahar
- Al-Masari Hayder
- Al-Masood Mohammed
- Al-Masri Mahmoud
- Al-Maswari Sakhr Abdulhakeem
- Al-Mohammad Abdulrahman
- Al-Mouakeh Ahmad
- Al-Mujaini Abdullah
- Al-Mukhaizeem Youssef
- Al-Naggar Hamza
- Al-Najjar Dania
- Al-Najjar Hani
- Al-Nawas Bilal
- Al-Oqabi Ayman
- Al-Oribi Saeid
- Al-Osta Malk
- Al-Othman Hadeel
- Al-Qannas Mohammad
- Al-Qannass Ali
- Al-Qattan Mohammad
- Al-Qurashi Qusay
- Al-Radi Osman
- Al-Raimi Ibrahim
- Al-Ramli Wisam
- Al-Rashdi Aya
- Al-Saadi Nina
- Al-Saban Rafat
- Al-Sabbagh Yusra
- Al-Shaiji Tariq
- Al-Shaikh Ghadeer
- Al-Shammakh Sonds
- Al-Shaye Ahmad
- Al-Shazly Mohammed Hamdy
- Al-Shehari Mohammed
- Al-Shibi Abdallah
- Al-Shudifat Abdel-Ellah
- Al-Sihan Mutlaq
- Al-Slaibi Ibrahim
- Al-Sukaini Ahmad
- Al-Surimi Dhyia Alhuq
- Al-Tamimi Yahia
- Al-Tarakji Mohannad
- Al-Terki Abdullatif
- Al-Thaher Mohammad
- Al-Urfan Mohammed
- Al-Uzri Muntadhir
- Al-Wandi Amna Salam
- Al-Yahri Omer
- Al-Yaseen Mustafa
- Al-Zaazaai Zakarya Abdullah
- Al-Zazay Karim
- Al-Zyadat Reham
- Alaa Sherif
- Alabbad Jasim
- Alabbasi Amira
- Alabdulkarim Yousof
- Alabi Ibrahim Abolaji
- Alabras Mohamad
- Aladaileh Ammar
- Aladawi Omar
- Alade Samuel
- Aladelusi Timothy
- Alafif Ali
- Alaglan Abeer
- Alahaidib Adel
- Alahdal Hani
- Alahmad Feras
- Alahmadi Ibrahim
- Alahmari Ahmed
- Alahmed Salman
- Alajaji Nouf
- Alajalen Amer
- Alajmi Suha
- Alajmi Turki
- Alakaloko Felix
- Alakeel Deem
- Alakhdury Amira
- Alaktaa Mohamed
- Alalawi Yousef
- Alali Mohammed
- Alam Ahmad Seraj
- Alam Azhar
- Alam Junaid
- Alam Mahmood
- Alam Mohammed Shadrul
- Alam Muhammad
- Alam Ruhina
- Alame Walid
- Alameen Hind
- Alameer Ehab
- Alammari Samer
- Alamri Ahmed
- Alamri Ossama
- Alannaz Omar
- Alaqeely Khalid
- Alaqel Sara
- Alarabi Alarabi
- Alarabi Rehab
- Alaradi Zuhair
- Alarcón Isaias
- Alarood Salameh
- Alarza Raquel
- Alasadi Ala
- Alasia Datonye
- Alasmari Mohammed
- Alassaf Mohammad
- Alassiri Ali
- Alatar Abdullah
- Alateeq Mohammed
- Alatiiga John Abanga
- Alatise Olusegun Isaac
- Alattas Zainab
- Alawadhi Abdulbari
- Alawadi Khalid
- Alawami Huda
- Alawami Mohammed
- Alawi Ahmed
- Alawi Khalil
- Alawneh Fade
- Alawneh Yazan
- Alayan Mohammed
- Alayande Barnabas
- Alayed Ahmad
- Alayed Nada
- Alayyoubi Hala
- Alazab Emad
- Alazabi Basma
- Alazzeh Ghaleb
- Alba J Jr
- Albaba Basil
- Albadawi Ismail
- Albader Ibtisam
- Albadi Zamzam
- Albaini Obey
- Albaiti Adel
- Albakry Ibrahim
- Albanese Erminia
- Albanopoulos Konstantinos
- Albargawi Ali
- Albarrak Abdullah
- Albarrak Majed
- Albasheer Mohammad
- Albastaki Aysha
- Albawardy Nof
- Albdah Abdullah
- Albendary Mohamed
- Alberici Laura
- Alberkamy Abdelrahman
- Albers Kim
- Albertsmeier Markus
- Albiol Maria Teresa
- Albishty Nouran
- Alborzi Majid
- Alburakan Ahmed
- Alburayh Bader
- Albzzaz Asem
- Alconchel Felipe
- Aldaghiri Khalid
- Aldahma Mohamed
- Aldakhil Ahmad
- Aldakhyel Lateefa
- Aldakkan Abdulrahman
- Aldalal Shuaib
- Aldana Joel
- Aldebeyan Wassim
- Alderazi Amer
- Aldhaam Naif
- Aldhurais Amirah
- Aldlyami Ehab
- Aldressi Wafa
- Aldridge Kerrie
- Aldrighetti Luca Antonio
- Aldulaijan Fozan
- Aldumaini Hamdan
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- Aleem Muhammad
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- Aleksandrova Evgeniya
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- Martinez Yicel Alvarez
- Maryam A
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- Mendoza Veronica Alonso
- Mensah Kwasi Agyen
- Mintah Dominic Annor
- Moagal Rehab Al
- Moawad Karim Abdelraouf
- Mohamed Mohamed Ali
- Mohsen Mustafa Abo
- Momani Tareg Al
- Muhfouz Dima Abu
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- Murgueitio Natalia Cortes
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- Obead Hamza Abu
- Oliver Renato Aguera
- Omair Shehanah Al
- Otaibi Faisal Al
- Picciochi Maria
- Pinto João Almeida
- Polo Miriam Abdulkarim
- Qadhi Hani Al
- Qudhaya Rashed Al
- Qureshi Talha Ahmed
- Rahim Norazila
- Rahman Noorneza Abdul
- Rahman Norhafiza
- Raisi Amani Al
- Rashed Asmaa Al
- Rego Juliana Almeida
- Riaz Shujat Ahmed
- Riobello Eva Andreu
- Riyami Nihal Al
- Riyami Salim Al
- Ros Conrado Andrés
- Roselló Irene Vives
- Rubio Eva Corral
- Rueda Ignacio Alcalá
- Saad Sarah Ahmed
- Sabti Hilal Al
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- Saied Ghiath Al
- Salam Omar Abdul
- Salama Ibrahim Abdelkader
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- Santos Daniel Costa
- Sayed Mohamed Al
- Sebastian Isabel Alonso
- Shaalah Ahmed Abdullah
- Shaibi Maha Al
- Shaikh Shafqat Ali
- Shanab Ahmed Abo
- Sharie Ahmed Al
- Shukri Asmaa Al
- Simoes Joana
- Smadi Omar Al
- Soares Rui Costa
- Soucheiron Maria Coronas
- Subaie Saud Al
- Suyyagh Kais Al
- Tarieh Ammar Abu
- Torres Eva Alvarez
- Victoria Czarlo Dela
- Villamayor Verónica Alen
- Vinayagam Raman
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- Vishwakarma Sunil Kumar
- Vishwani Vartika
- Vissapragada Ravi
- Viste Claire
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- Viveros-Carreño David
- Vives Inmaculada
- Vives-Barquiel Marian
- Vivian-Taylor Josephine
- Vix Michel
- Vlad Ioan Catalin
- Vlad Schitcu
- Vladimir Novgorodskii
- Vleminckx Nils
- Vo Uyen Giao
- Vogel Jon
- Vogel Keianna
- Vogel Rachel
- Vogelsang Holger
- Vogler Thomas
- Vogt Kelly
- Vohra Ravinder
- Vokshi Ismail
- Volkova Olga
- Volpe Gustavo Jardim
- Volpin Enrico
- Volpin Francesco
- von Ehrlich-Treuenstätt Viktor H
- von Renesse Janusz
- von Rundstedt Friedrich-Carl
- Voonna Murali Krishna
- Voppuru Saiesh Reddy
- Vora Sameer
- Voros Peter
- Vosoughi Fardis
- Vossler Kristen
- Vounckx Manon
- Vourganti Srinivas
- Vovola Fernanda
- Vozian Marin
- Vrakopoulou Gavriella Zoi
- Vömel Jacob
- Wadei Hajr Al
- Yahya Zakaria Al
- Zahran Mohammed
- Zahrani Attiya Al
- Zahrani Turki Ai
- Zaid Muna
- Zein Zeina Al
- Álvarez Sofia
- Älgå Andreas
- Publication venue
- 'Oxford University Press (OUP)'
- Publication date
- 01/01/2021
- Field of study
Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.
Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.
Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.
Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population
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
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- Dominguez Joaquina
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- Wondoh Paul M.
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- Wong Hsu Ven
- Wong Jane J
- Wong Jeremy
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- Woon-Shoo-Tong Xiao-Ming Sarah
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- Yaghi Yasmine
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- Yakushkina Al'ona
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- Yang P Zichu
- Yanikoglu Erkan
- Yanni Fady
- Yates Charlotte
- Ye Geoffrey
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- Yenli Edwin
- Yeo Jeremy
- Yeoh Andrea
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- Yildirim Reyyan
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- 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
- 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
- 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 O
- Adenuga Adedire
- Aderounmu Adewale
- Adesanya Opeoluwa
- Adesina Alaba
- Adesunkanmi Abdul-Rashid
- Adeyeye Ademola
- Adidharma Peter
- Adisa Adewale
- 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
- Alemdağ 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
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- Forero-Torres Alexander
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- Foschi Diego
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- Zakaria Andee Dzulkarnaen
- Zakaria Mai
- Zakaria Omar
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- Zammit Matthew
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- 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