Surgical multicenter collaborative studies: ¿What happen in Latin America?

Antecedentes: GlobalSurg es un grupo internacional de investigadores que tiene como propósito la conducción y la diseminación de robustos estudios colaborativos, internacionales y multicéntricos. Objetivo: Exponer las estrategias necesarias y las barreras encontradas en la conducción de estudios multicéntricos masivos en cirugía. Método: Durante el segundo semestre del año 2020 se llevó a cabo el estudio Surg-Week Prospective International Cohort Study, hasta la fecha el estudio internacional más grande en el campo de la cirugía, con 141,582 pacientes incluidos. Un total de 4975 miniequipos, de uno a cinco integrantes, recopilaron datos de 116 países de todos los continentes. Resultados: La creación de un sitio web oficial del estudio, reportes con información relevante vía e-mail o grupos vía WhatsApp, conformación de un comité de diseminación del protocolo, dictado de webinars sobre publicaciones recientes del equipo, designación de líderes nacionales e internacionales, y la divulgación por medio de sociedades, fueron las estrategias utilizadas para el desarrollo de la investigación. Sin embargo, las barreras detectadas para llevar a cabo el estudio multicéntrico fueron variadas. Conclusiones: Los trabajos colaborativos permiten establecer redes entre diferentes profesionales con el fin de mejorar la calidad de la gestión, las políticas sanitarias y la atención a los pacientes en tiempos de constante cambio.Background: GlobalSurg is an international group of researchers whose purpose is to conduct and disseminate robust collaborative, international and multicenter studies. Objective: To expose the necessary strategies and the barriers crossed in conducting massive multicenter studies in surgery. Method: During the second semester of 2020, the study Surg-Week Prospective International Cohort Study was carried out. Surg-Week has been the largest international study in the field of surgery to date, with 141,582 patients included. A total of 4975 mini-teams, of between 1 and 5 members, collected data from 116 countries on all continents. Results: The creation of an official website for the study, reports with relevant information via email or groups via WhatsApp, formation of a Dissemination Committee of the protocol, delivery of webinars on recent team publications, appointment of leaders at the national and international level, and outreach through partnerships, were the strategies used for the development of the research. However, the barriers turned out to involve different aspects. Conclusions: Collaborative work allows establishing networks between different professionals with the goal of improving the quality of management, health policies and care of our patients in a timely manner of constant change

Aplicación académica de mensajes de texto en un curso de primeros auxilios: estudio piloto en una universidad privada de Lima, Perú

The aim of the study was to develop and evaluate the impact of an educational intervention with the use of text messages (SMS) in a first aid course. A prospective study and intervention was conducted. Two steps were implemented: 1) a qualitative study to design the SMS and 2) the intervention with the sending of the SMS messages. The outcome variable was the final grade of students. Multivariate models were constructed, prevalence ratios and confidence intervals at 95% were calculated. The first phase revealed that the SMS should be educational-theoretical, motivational, and multiple choice. In the intervention there were 66 participants in the control and intervention group. The average age was 17.7 (± 1.2) years. The intervention group obtained higher scores compared with the control group (PR = 4.82; 95% CI: 1.58 to 14.72). Inconclusion, SMS with informative and motivational content is useful in the formation of undergraduate medicine.El objetivo del estudio fue desarrollar y evaluar el impacto de una intervención educativa con el uso de mensajes de texto (SMS) en un curso de primeros auxilios. Se realizó un estudio prospectivo y de intervención. Se implementaron dos etapas: 1) estudio cualitativo para diseñar los SMS, 2) intervención con el envío de los SMS. La variable resultado fue la nota final de los alumnos. Se construyeron modelos multivariados y se calculó razones de prevalencia e intervalos de confianza al 95%. La primera fase reveló que los SMS debían ser educativos-teóricos, motivacionales, y tipo test. En la intervención hubo 66 participantes en el grupo control e intervención. La edad promedio fue 17,7 (±1,2) años. El grupo intervención obtuvo calificación mayor en comparación con el grupo control (RP=4,82; IC 95%: 1,58-14,72). En conclusión, los SMS con contenido informativo y motivacional son útiles en la formación del pregrado en Medicina

Aplicación académica de mensajes de texto en un curso de primeros auxilios: estudio piloto en una universidad privada de Lima, Perú

El objetivo del estudio fue desarrollar y evaluar el impacto de una intervención educativa con el uso de mensajes de texto (SMS) en un curso de primeros auxilios. Se realizó un estudio prospectivo y de intervención. Se implementaron dos etapas: 1) estudio cualitativo para diseñar los SMS, 2) intervención con el envío de los SMS. La variable resultado fue la nota final de los alumnos. Se construyeron modelos multivariados y se calculó razones de prevalencia e intervalos de confianza al 95%. La primera fase reveló que los SMS debían ser educativos-teóricos, motivacionales, y tipo test. En la intervención hubo 66 participantes en el grupo control e intervención. La edad promedio fue 17,7 (±1,2) años. El grupo intervención obtuvo calificación mayor en comparación con el grupo control (RP=4,82; IC 95%: 1,58-14,72). En conclusión, los SMS con contenido informativo y motivacional son útiles en la formación del pregrado en Medicin

Aplicación académica de mensajes de texto en un curso de primeros auxilios: estudio piloto en una universidad privada de Lima, Perú

El objetivo del estudio fue desarrollar y evaluar el impacto de una intervención educativa con el uso de mensajes de texto (SMS) en un curso de primeros auxilios. Se realizó un estudio prospectivo y de intervención. Se implementaron dos etapas: 1) estudio cualitativo para diseñar los SMS, 2) intervención con el envío de los SMS. La variable resultado fue la nota final de los alumnos. Se construyeron modelos multivariados y se calculó razones de prevalencia e intervalos de confianza al 95%. La primera fase reveló que los SMS debían ser educativos-teóricos, motivacionales, y tipo test. En la intervención hubo 66 participantes en el grupo control e intervención. La edad promedio fue 17,7 (±1,2) años. El grupo intervención obtuvo calificación mayor en comparación con el grupo control (RP=4,82; IC 95%: 1,58-14,72). En conclusión, los SMS con contenido informativo y motivacional son útiles en la formación del pregrado en Medicin

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort 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

© 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

© 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