Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Pleistocene terrace deposition related to tectonically controlled surface uplift: an example of the Kyrenia Range lineament in the northern part of Cyprus

AbstractIn this study, we consider how surface uplift of a narrow mountain range has interacted with glacial-related sea-level cyclicity and climatic change to produce a series of marine and non-marine terrace systems. The terrace deposits of the Kyrenia Range record rapid surface uplift of a long-lived tectonic lineament during the early Pleistocene, followed by continued surface uplift at a reduced rate during mid-late Pleistocene. Six terrace depositional systems are distinguished and correlated along the northern and southern flanks of the range, termed K0 to K5. The oldest and highest (K0 terrace system) is present only within the central part of the range. The K2–K5 terrace systems formed later, at sequentially lower levels away from the range. The earliest stage of surface uplift (K0 terrace system) comprises lacustrine carbonates interbedded with mass-flow facies (early Pleistocene?). The subsequent terrace system (K1) is made up of colluvial conglomerate and aeolian dune facies on both flanks of the range. The later terrace systems (K2 to K5) each begin with a basal marine deposit, interpreted as a marine transgression. Deltaic conglomerates prograded during inferred global interglacial stages. Overlying aeolian dune facies represent marine regressions, probably related to global glacial stages. Each terrace depositional system was uplifted and preserved, followed by subsequent deposits at progressively lower topographic levels. Climatic variation during interglacial–glacial cycles and autocyclic processes also exerted an influence on deposition, particularly on short-period fluvial and aeolian deposition

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London