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

Can the "Euro-leaf" logo affect consumers' willingness-to-buy and willingness-to-pay for organic food and attract consumers' preferences? An empirical study in Greece

The "Euro-leaf" organic certification logo was adopted and made compulsory by the European Union (EU) a few years ago; the level of consumers' recognition of this logo has been explored. This paper provides important insights into the effectiveness of the logo in the Greek market. The "Euro-leaf" logo was compared with the two previous EU organic logos; i.e., the voluntary "Organic Farming" and the withdrawn "Bio". In total, 472 face-to-face interviews were conducted using actual presentations of five officially certified food products. The aim of this research was to investigate the consumers' willingness-to-buy (WTB), willingness-to-pay (WTP), and their preference towards each of the three logos used for the certification of organic products. Our analysis concludes that for the time being the new logo has failed to develop into a powerful instrument for affecting consumers' WTB and WTP. Furthermore, it was found to have been the least influential factor that determined their preferences. Design changes and improvements might be necessary in order to better communicate the organic food message.</p

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

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