5 research outputs found
Infección por VPH en mujeres con artritis reumatoide
- Author
- Publication venue
- UANL Facultad de Medicina
- Publication date
- 01/01/2008
- Field of study
Antecedentes: el virus del papiloma humano (VPH) es el principal factor de riesgo de cáncer de cuello uterino, que sigue siendo la neoplasia más frecuente en nuestro país. Existen datos que muestran que los pacientes con inmunosupresión son más propensos a la infección por VPH.
Objetivo: determinar la frecuencia de la infección por VPH en pacientes con artritis reumatoide comparada con mujeres pareadas por edad de población abierta.
Material y métodos: estudio transversal, comparativo y observacional en mujeres con artritis reumatoide y mujeres sin enfermedad reumática a las que se les realizó citología cervical, detección y tipificación del VPH. Se analizaron los datos mediante las pruebas de la ji al cuadrado, exacta de Fisher, Mann Whitney y razón de momios. Resultados: se incluyeron 77 mujeres con artritis reumatoide comparadas con un grupo de 77 mujeres sin artritis reumatoide y de edad similar. Se encontró una frecuencia de infección por VPH en 37 pacientes con artritis reumatoide (48%) contra 17 mujeres sin ésta (22%) [OR 3.1551 IC 95%(1.56 – 6.35) p= 0.001]. Los tipos de VPH 83 y 59 fueron más frecuentes en las mujeres con artritis reumatoide mientras en los controles se encontró el 59, 81 y 54. No se encontró relación con la duración de la enfermedad, el uso de esteroides o inmunosupresión.
Conclusiones: la infección por VPH es más frecuente en mujeres con artritis reumatoide comparada con las que no tienen esta enfermedad reumática
International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module
- Author
- Abdullah Mufareh Assiri
- Abeer Ahmed Mohmed
- Abeer Aly Omar
- Abhijeet Raha
- Abizer Nuruddin Manked
- Achilleas Gikas
- Adela Arguello Ruiz
- Adem Karbuz
- Adrian M. Puello Guerrero Glenny Mirabal
- Adriana Montanini
- Adriana Romani
- Afzal Azim
- Agamenon Alves Oliveira
- Agreta Gecaj-Gashi
- Ahmed Hakawi
- Ahmet Dilek
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- Alexander Tchekulaev
- Alfredo Lagares Guzman
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- Yuri Mariela Perez Hernandez
- Yvis Ruiz
- Zan Mitrev
- Zaneta Bogoevska-Miteva
- Zeina Kanafani
- Zeinab Salah Seliem
- Zenaida Durán Gil De Añez
- Zeynel Gokmen
- Zeynep Kaya
- Ziad Ahmed Memish
- Zoila Rosa Diaz Tavera
- Zoila Rosa Diaz Tavera
- Çağlar Ödek
- Publication venue
- Elsevier Inc
- Publication date
- 01/09/2014
- Field of study
We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN
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
- 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
- Adenuga Adedire
- Aderounmu Adewale
- Adesanya Opeoluwa
- Adesina Alaba
- Adesunkanmi Abdul-Rashid
- Adeyeye Ademola
- Adidharma Peter
- 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
- Alemdag 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
- Alwerfally AbdulMawlay
- Alwhaidi Noor
- Alyafi Amr
- Alzabti Fatima
- Alzahaf Ahmed
- AlZohour Mohammad
- Amadou Magagi Ibrahim
- Amandito Radhian
- Amarin Justin Z.
- Amaro Margarida
- Ambrazevicius Marijus
- Amendola Alfonso
- Amin Leila
- Amine Souadka
- Amjad Talal
- Amorim Edgar
- Amro Adham
- Anandan Premkumar
- Anas khalifa Rawda
- Anastasio Lorenzo
- Andersson Yvette
- Andreotti Dario
- Andrew David
- André Benoît
- Ang Sue Ean
- Angel Miguel
- Anggita Gultom Phebe
- Annapureddy Naga
- Anokhin Evgeny
- Ansaloni Luca
- Ansarei Dhirar
- Ansari Abdul Basit
- Antaky Marco
- Anthony Natasha
- Anthoulakis Christos
- Antonopoulou Maria Ioanna
- Anwar Mohamed
- Anwer Abdul Wahid
- Anyanwu Chikamuche
- Anyanwu Lofty-John
- Anyanwu Mercy Chinemerem
- Anyomih Theophilus Teddy Kojo
- Appukuttan Akhila
- Aquilino Fabrizio
- Archibald Jess
- Arciénega Yañez María del pilar
- Argentou Maria-Ioanna
- Argudo Nuria
- Argyriou Eleftherios Orestis
- Arias Madrid Natalia
- Aribi Sarra
- Arifin Ghafur Rasyid
- Arizpe Daniel
- Arnaud Alexis P
- Arora Bharti
- Arora Deeksha
- Arowolo Olukayode
- Arrangoiz Rodrigo
- Arslan Ekin
- Artigau Eva
- Ashfaq Ahsan
- Ashour Dina
- Ashour Firas
- Ashoushan Hana
- Ashraf Ahmed
- Ashraf Alaa
- Asif Ashar
- Asnel Dorisme
- Asok Anjitha
- Assa Rawan
- Assalhi Mohamed
- Asta Martina
- Asti Emanuele Luigi Giuseppe
- Atakul Onur
- Atallah Khalid
- Atanasov Boyko
- Atawneh Mohammad
- Athamneh Sarah
- Ather Muaaz
- Athisayaraj Thomas
- Atkociunas Aivaras
- Attia Mohamed
- Au Angela
- Awad Israa
- Awadallah Haneen
- Awaji Kholoud
- Awesat Eman
- Awolowo Ajibola
- Ayandipo Omobolaji
- Ayash Mohammad
- Ayau Fernanda
- Ayesh Kholoud
- Ayman El-sawy Esraa
- Ayoub Rami
- Aytac Erman
- Ayub Bushra
- Ayub Saima
- Ayyad Rawan
- Azevedo José
- Azodo Ijeoma
- Azzubia Joma
- B L Ashika
- Ba Mouhamadou Bachir
- Babaa Basheer
- Babirye Lilian
- Bacic Ivan
- Badr Esraa Tarek
- Badr Helmy
- Badran Abdul
- Badwe Rajendra
- Bafford Andrea Chao M.D.
- Baggaley Caitlin
- Bahroun Sumayyah Ghayth
- Baiao José Miguel
- Baiocchi Daniella
- Bairos Menezes Maria
- Baiu Ioana
- Bajilan Mohammad
- Bajomo Oreoluwa
- Bake Jacques
- Baki Bahadir Emre
- Bakoleas Panagiotis
- Balaawi Reem
- Balalis Dimitrios
- Balata Mohamed
- Balkarov Artem
- Ballouhey Quentin
- Balogun Olanrewaju
- Baloyiannis Ioannis
- Baltaci Ege
- Bamaca Ixcajoc Elvis Benjamin
- Banaz Tuba
- Banda Bitiel
- Banglani Muntaha
- Bani Hani Farah
- Bani hani Mohammad
- Bani hani Zeina
- Baniowda Muath
- Banks Alexander
- Bannister Sharon
- Baranyai Zsolt
- Barati Nastaran
- Barbosa Camacho Francisco José
- Barbosa José
- Bardos David
- Barendegere Venerand
- Barghuthi Lutfi
- Barhoush Ola
- Barnes Nicole
- Baronio Gianluca
- Barreda Zelaya Lilian Elizabeth
- Barrera López Francisco Javier
- Barsic Neven
- Barter Charlotte
- Bartosiak Katarzyna
- Basarab Maksym
- Basso Stefano Maria Massimiliano.
- Bastiaenen Vivian
- Batashki Ilia
- Bath Michael
- Beattie Miriam
- Bedada Alemayehu Ginbo
- Belais Fanny
- Belal qadomi Asef
- Belev Nikolay
- Belli Andrea
- Beltrán de Heredia Juan
- Belvedere Angela
- Ben Dallah Najah
- Ben Saoud Abdulsalam Ali
- Bengur Fuat Baris
- Benkabbou Amine
- Benke Marton
- Benyaiche Chaymae
- Bergeat Damien
- Bernstein Mitchell
- Beshtawi Doha
- Besli Sevval
- Beuran Mircea
- Bhandare Manish
- Bhangu Aneel
- Bhatti Muhammad Iqbal
- Bianchini Stefania
- Bianco Francesco
- Bibas Fatma
- Biccard Bruce M
- Bielosludtsev Oleksii
- Bienfait Mumbere
- Billy Matthew
- Bin Mohamad Sithik Muhammad Navid
- Binetti Margherita
- Bingham Janne
- Bird Jonathan
- Birindelli Arianna
- Birks Sarah
- Birutis Justas
- Björklund Ida
- Blackman Brighid
- Blackwell James
- Blanco-Colino Ruth
- Blok Robin
- Blomme Nina
- Blomqvist Malin
- Blunnie Eimear
- Bnhameida Sondos
- Boddy Alex
- Bodur Muhammed Selim
- Boereboom Catherine
- Bogusevicius Algirdas
- Bolzonaro Elisa
- Bonavina Luigi
- Bondurri Andrea
- Bonghaseh Divine Tim
- Bono Lorenzo
- Borda-Luque Giuliano
- Borg Elaine
- Borghi Felice
- Borham Hala
- Borowski David W
- Bortolasi Luca
- Bosch Marina
- Bosire Fridah
- Bossi Daniela
- Botes Azel
- Bouaziz Hanen
- Bougard Heather
- Boutall Adam
- Boutros Marylise
- Bouzaiene Hatem
- Boyce Stephen
- Boyd-Carson Hannah
- Boyle Connor
- Braccio Bartolomeo
- Bradulskis Saulius
- Brata Santi Yuanita
- Bratu Matei Razvan
- Brito Diana
- Brocklehurst Peter
- Brooker Ethan
- Brooks Savannah
- Brown James
- Bruce Eilidh
- Bsisu Isam
- Bua Emmanuel
- Bucci Luigi
- Budd Gabrielle
- Budzynski Andrzej
- Budzynski Piotr
- Bujda Michele
- Bulaya Anadi
- Bullock Cameron
- Burgu Gökçen
- Burke Daniel
- Burman Shivang
- Bury Pawel
- Busuttil Zachary
- Butt Eman
- Buxant Frederic
- Buzaite Kristina
- C S Archana
- Caballero Díaz Yurena
- Cabrera Rivera Paulo Andrés
- Cagigas Fernandez Carmen
- Calik Adnan
- Calleja Thomas
- Camelo Saul
- Camilo Correa Juan
- Caminsky Natasha
- Cammarata Francesco
- Campagnaro Tommaso
- Campanella Sofia
- Campanelli Michela
- Campo Veronica
- Campos Costa Filipa
- Campos Maite
- Candas Altinbas Bahar
- Canic Renata
- Canonica Claudia
- Canonico Silvestro
- Canotilho Rita
- Cansana Bernalynn Eris
- Capote Hugo
- Capunge Ines
- Carballo Federico
- Cardia Roberto
- Cardoso Louro Hugo
- Cardoso Diogo
- Cardoso Vasco
- Carella Marcella
- Carlini Massimo
- Carrano Francesco Maria
- Carrington Emma Victoria
- Caruso Emanuele
- Carvalho Ana Cristina
- Carvalho Lúcia
- Carvalho Márcia
- Carvello Michele Maria
- Castaldi Antonio
- Castanedo Bezanilla Sonia
- Castilla Moreno Miguel Angel
- Castillo Arrascue José Neiser
- Castillo Barbosa Andrea Carolina
- Castro López Elizabeth Victoria
- Castro Ernes John
- Castro Luis
- Catarino Santos Sara
- Cañete Joannes Paul
- Ceballos André
- Celebioglu Fuat
- Celentano Valerio
- Cenal Ulukan
- Cengiz Yucel
- Cepuliene Daiva
- Cervone Carmela
- Cesleviciene Ieva
- Cesna Vaidotas
- Chabok Abbas
- Chachaima Mar Jorge Emerson
- Chacòn-Herrera Patricia
- Chaggar Gurpreet
- Chamberlain Carla
- Chambers Alice
- Chan Claudia
- Chan Erick
- Chandler Julia
- Chandrasinghe Pramodh
- Chang Ern Ng
- Chanousi Iris
- Chantalat Elodie
- Chapman Gavin
- Charalabopoulos Alexandros
- Charalampidou Lydia
- Charman Lillian
- Chatzakis Christos
- Chau Charlene Yat Che
- Che Husin Nurfariza
- Cheong Yih Jeng
- Chetta Nicola
- Chibuye Chali
- Chieng Loo Ling
- Chinchihualpa Paredes Nathaly Olga
- Chinnery Galya
- Chircop Kurt Lee
- Chirengendure Bright
- Choi Seung il
- Chong Chester
- Chopra Prakshi
- Chopra Sharat
- Chouliaras Christos
- Chow Bing Lun
- Chrapko Phillip
- Christodoulides Natasha
- Christoforidis Dimitrios
- Christou Niki
- Chrol Maciej
- Chu Kathryn
- Chu Michael Jen Jie
- Cianchetti Ettore
- Cicuttin Enrico
- Cifrian Canales Isabel
- Ciftci Ahmet Burak
- Cihanyurdu Irem
- Cillara Nicola
- Cinza Margarida
- Cirelli Riccardo
- Cirillo Bruno
- Cirillo Bruno
- Ciubotaru Cezar
- Cizauskaite Agne
- Clark Gemma
- Clark Laura
- Clarke Damian
- Claro Mariana
- Clements Hollie A
- Clements Joshua Michael
- Clerc Daniel
- Clonda Octavian
- Coburn Natalie
- Coccia Anna
- Cocco Annelise
- Cockbain Andrew J
- Cocorullo Gianfranco
- Coleman Maggie
- Colli Francesco
- Colombo Francesco
- Compagnoni Bruno
- Condie Natalie
- Confalonieri Gianmaria
- Connors Joseph
- Contreras Saiz Elisa
- Conway Alison
- Cordera Fernando
- Corea Ruiz Ligia Margarita
- Cornwall Hannah
- Correia Ana Margarida
- Corrigan Robert
- Corro Díaz González Samantha
- Corsi Fabio
- Cortes-Flores Ana Olivia
- Costa Santos Daniel
- Costa Santos Maria Teresa
- Costa-Maia Jose
- Costanzo Antonio
- Costas-Chavarri Ainhoa
- Coulter-Nile Sarah Michelle Crystal Jade
- Cowan Sarah
- Crawford James
- Crocetti Daniele
- Crutcher Madison
- Cruz González Efraín
- Cruz Martins Marta Cristina
- Ctercteko Grahame
- Cuba Vicente
- Cubas Santiago
- Cuk Vladica
- Cunha Miguel F.
- Curletti Gianluca
- Currow Chelise
- Curry Heather
- Curtis Martínez Carolina
- Cutajar Ruth
- Czerwinska Agata
- Cömert Didem
- D'Alessandro Nicola
- Da Silva Medina Luis
- Dabin Elsa
- Dahy Ahmed
- Dailidenas Sarunas
- Dainius Edvinas
- Dal Molin Marco
- Damianov Nikolai
- Damján Pekli
- Damuleviciene Gyte
- Danial Aghyad
- Daniels Ian
- Daniyan Muhammad
- Danys Donatas
- Daraghmeh Laith
- Dardanov Dragomir
- Dare Anna
- Das Andre
- Davidson Sophie
- Davis Laura
- Davis Rowan
- Dawidziuk Aleksander
- Dawoud Amr
- Dawson Amanda Caroline
- De Azevedo Bernardo
- De Castro Parga Gonzalo
- De Giovanni Jasmine
- de Jonge Joske
- de la Torre Javier
- De Luca Emilia
- De Marco Paolino
- de Muijnck Cansu
- de Oliveira Daniela
- De Rosa Michele
- De Santiago Alvarez Irene
- De Silva April
- De Silva Kasun
- De Simone Veronica
- de Sousa Xavier
- De Toma Giorgio
- Deans Chris
- DeBiasio Ashe
- Deepika Garg
- Delhen Malik
- Dell Angela
- Delrio Paolo
- Demartines Nicolas
- Demirkaya Hasan Can
- Demolin Rodrigo
- den Boer Frank
- Deng Idy
- Dennis Grace
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- Devesa Helena
- Devezas Vítor
- Dhital Bal
- Di Candido Francesca
- Di Lascio Pierpaolo
- Di Maso Sara
- Diab Samar
- Diachenko Andrii
- Diaconescu Bogdan
- Diallo Adja Coumba
- Dickfos Marilla
- Dimech Andrew Michael
- Dimitrov Dobromir
- Dinuzzi Vincenza Paola
- Diéguez Beatriz
- Doe Matthew
- Dogruoz Alper
- Doherty Ronan J
- Dollie Qaasim
- Dominguez Genieve
- Dominguez Joaquina
- Domini Edgar
- Dossou Francis
- Dousset Bertrand
- Draganic Brian
- Drake Thomas M
- Drane Andrew
- Duarte Marina
- Dudi-Venkata Nagendra Naidu
- Duggan William
- Duke Kathryn
- Duller Alexander
- Dulskas Audrius
- Dumitra Sinziana
- Dural Ahmet Cem
- Dworak Jadwiga
- Dzhumabaev Khasan
- Dziedzic Jacek
- Díaz Vico Tamara
- Eaazim Jose
- Eardley Nicola
- Echeverria-Davila Guillermo
- Edirisooriya Monisha
- Eerola Verner
- Eid Esraa
- Eismontas Vitalijus
- Eklöv Karolina
- Ekpete Ogbonnia
- Ekwen Gerald
- El Gharmoul Tasnim
- El Jamassi Alaa
- El Muhtaseb M.S.
- El Nakeeb Ayman
- El sheikh Enas
- El Zoghby Naira
- El-Kahlout Sahar
- El-remaily Amira
- El-Sawy Aya
- El-taweel Alaa
- Elazab Yasmin
- Elbarouni Sofian
- Elbealawy Mohamed
- Elbeshina Aya Elseed
- Elblbessy Mahmood
- Eldeep Ahmed
- Eldeep Mostafa
- Eldmaty Asmaa
- Eldoseuky mohammed Amany
- Elemile Peter
- Elewaily Mohamed Ibrahim Elsayed
- Elfaituri Taha
- Elfallal Ahmed
- Elfanty Mahmoud
- ElFayoumy Ahmed Moustafa
- Elfeki Hossam
- Elfizri Zatira
- Elgammudi Mala
- Elghareeb Nourhan
- Elhadi Ahmed
- Elhadi Muhammed
- Elhajjaji Yasmine
- Elhelow Esraa
- Elhout Somaya
- Elkabir Osama
- Elkhadragy Ahmed
- Elkhalawy Aya
- Ellaby-Hall Jordan
- Ellul Sarah
- Elmahdy Marwa
- Elmeslemany Nehal
- Elmokadem Aya
- Elqadi Muawiyah
- Elrais Safa
- Elsayed Mai
- Elsayed Mohammad
- Elshafei Houssein
- Elshafey Ahmed
- Elshaibani Mahmoud
- Elshatby Bassant
- Elshawy Mohamed Elemam
- Elsherbeny Mohammed Yasser
- Elsherif Fawzia
- Elshimy Ahmed
- Elsobky Hager
- Elteir Hana
- Eltoum Ruba
- Elzanfaly Ali Abdelazez
- Emara Eman
- Emeghara Okechukwu
- Emile Sameh
- Enumah Zachary
- Eraslan Huseyin
- Eray Ismail Cem
- Erkul Oguz
- Esbaga Fatima
- Escobar Dennis
- Escrevente Ricardo
- Eskander John
- Eslam Sara
- Esmat Nourhan Ahmed
- Esper Asil
- Espin-Basany Eloy
- Espina Perez Beatriz
- Espinosa-Bravo Martin
- Esposito Giovanni
- Essam Ibrahim El Desouki Muhammad Ahmed Muhammad
- Essam Eman
- Estalagem Inês
- Estevez Tesouro José
- Eswaye Haitem
- Etchill Eric
- Etonyeaku Amarachukwu
- Eusebio Zegarra Ivan Edward
- Ezzat Helmy
- Fadel Ahmed
- Fahira Alessa
- Fahmawee Toqa
- Fairfield Cameron J
- Falato Armando
- Falco Giuseppe
- Falco Nicolò
- Fareleira Ana
- Fares Bucci Andrea
- Fares Jehad
- Farid Mohammad
- Farik Shebani
- Farina Pablo
- Farnan Richard
- Farooq Muhammad
- Farsi Ali
- Fasolini Fabrizio
- Faustin Ntirenganya
- Fayed Notila
- Fazenda Ana
- Felicia Devi
- Felix Rosa
- Feng Daniel
- Fermani Claudio Gabriel
- Fernandes Cristina
- Fernandes Sara
- Fernandez Arias Sebastian
- Fernandez-Diaz Maria Jose
- Fernandez-Hevia Maria
- Fernández Martínez Daniel
- Fernández Veiga Maria Pilar
- Ferrari Guglielmo
- Ferreira Fernandes Martin
- Ferreira Andreia
- Ferreira Pedro
- Ferrero Esther
- Ferri Lorenzo
- Fialho Guilherme
- Figueiredo Ana Gabriela
- Finlay Ben
- Fitchat Nicolas
- Fitzgerald J Edward
- Flamey Nicolas
- Flannery Oliver
- Fleming Christina
- Fleming Hannah
- Flores Mario-Andrés
- Fonseca Telma
- Fontana Tommaso
- Fontanilla Mark Anthony
- Forero-Torres Alexander
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- Wondoh Paul M.
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- Yaghi Yasmine
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- Yates Charlotte
- Ye Geoffrey
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- Yenli Edwin
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- You Lucia
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- Yusuf Baasil
- 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
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- Ahmad Izzuddin Ahmad Imran
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- Dominguez Joaquina
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- Eldoseuky mohammed Amany
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- Elewaily Mohamed Ibrahim Elsayed
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- Elshawy Mohamed Elemam
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- Essam Ibrahim El Desouki Muhammad Ahmed Muhammad
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- Falato Armando
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- Forero-Torres Alexander
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- Ghonaim Mennatullah
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- Gnintedeme Olivier Tchianze
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- Wondoh Paul M.
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- Wong Tsz Lun Ernest
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- Yabut Kenneth
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- Yaghi Yasmine
- Yahia Mohamed Ali Mohamed
- Yakushkina Al'ona
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- Yang P Zichu
- Yanikoğlu Erkan
- Yanni Fady
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- Ye Geoffrey
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- Yenli Edwin
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- Yilmaz Duygu
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- Yusuf Baasil
- 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
- 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
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
- Author
- Aarts Frits
- Ababneh Hazim
- Abad-Motos Ane
- Abaidalla Ahmed
- Abbakar Malaz
- Abd El Aal Ahmed
- Abd-Errazik Mohammad Ahmad
- Abdalradiy Abdalrahmman G
- Abdelkhalek Mohamed
- Abdelkhalek Mostafa
- Abdellatif Ahmed
- Abdellatif Mohamed
- Abdelsaid Kirolas
- Abdou Khaled
- Abdulfatah Mustapha
- Abdullah Mohammad Amer
- Abdullahi Mustapha Miko Mohammed
- Abellán Antonio Melero
- Abeysinghe Nayana
- Abiyere Henry
- Achimas-Cadariu Patriciu Andrei
- Adakaya Sıla
- Adam Nicolas
- Adams Benita
- Adams Ferdinand
- Adegboye Kazeem
- Adeyeye Ademola
- Adra Lama
- Adu-Poku Patricia
- Afuwape Oludolapo
- Afzal Ameer
- Afzal Muhammad Farooq
- Agapov Mihail
- Agara Daniel
- Aggarwal Manisha
- Agger Erika
- Aghadi Ifeanyi Kene
- Ahmed Amjed Yassir
- Ahmed Haleemasahdia
- Ahmed Khalil
- Ahmed Manar
- Ahmed Masood
- Ahmed Safia
- Ahn Hong Min
- Aibe Raquel
- Aigner Felix
- Aissat Abdenour
- Aitbaeva Arai
- Akay Omer
- Akbar Ali
- Akbas Ahmet
- Akere Abidemi
- Akesen Selcan
- Akgun Erhan
- Akhtar Naseem
- Akın Emrah
- Akova Elif
- Aktas Serhat
- Akçay Özlem
- Al Masri Mahmoud
- Al-Alnsi Ahmed
- Al-Hutheifi Roqia'A
- Al-Jarrah Amar
- Al-Naggar Hamza
- Al-Shehari Mohammed
- Alamin Nadeen
- Alawi Raneen
- Alawlaqi Dina
- Alawneh Fade
- Alberola Maria José
- Albers Michael
- Alcolea Natalia González
- Aleem Muhammad
- Alegre Inês
- Alegre Javier Martinez
- Alexandre Flavia
- Alexandrescu Corina
- Alexnder Abelevich
- Alexopoulou Kalliopi
- Alfonso Beatriz Amorós
- Ali Ahmed
- Ali Che Saniati Che
- Ali Danish
- Ali Madeeha
- Ali Mahmoud Abdelwahab
- Ali Manhal Hashim
- Ali Noura Al
- Alikhanli Jhale
- Aliyeva Zumrud
- Aliyu Mohammed
- Aljawder Hasan
- Allen Kate
- Almahmeed Ebrahim
- Alonso Alfredo
- Alonso Javier Etreros
- Alsamneh Muneer
- Alsayadi Ramzi
- Altinel Yuksel
- Altintoprak Fatih
- Altomare Donato F
- Alvarenga Isabella
- Alvarez Laura Jimenez
- Alvarez-Bautista Francisco Emmanuel
- Alvarez-Díez Marcos
- Alves Brenda Chayanny
- Amadigwe Rita
- Amado Andreia
- Amado Fabíola
- Amador Cristina García
- Amanullah Nazli
- Amaral Hélida Aline Tomacheski
- Amaral Luis
- Amin-Tai Hizami
- Aminu Bashiru
- Amir Ahmad Suhaimi
- Ammar Ahmed Siddique
- Ammar Mona Ahmed
- Ammendola Michele
- Ammerata Giorgio
- Amorim Edgar
- Ancans Guntis
- Anderson Tom
- Andrade Diogo
- Andrejevic Predrag
- Andrés Beatriz Díaz San
- Anestiadou Elissavet
- Ang Chin Wee
- Angelo Franceschi
- Anokhin Evgeny
- Anoldo Pietro
- Antakia Ramez
- Anton Majd
- Antonelli Serena
- Antropoli Carmine
- Anula Rocio
- Anwar Jamal
- Anyadike Florence
- Apostolakidou Magda
- Apostolidi Eirini
- Aprea Giovanni
- Arabadzhiev Angel
- Arakawa Satoshi
- Arauz Jazmin
- Aravindan U
- Aremu Abdurrahman
- Aremu Isiaka
- Argawy Osama
- Arican Can
- Arida Zahed Abu
- Armellin Claudia
- Arnaoutoglou Eleni
- Arreguy-Borges Kanthya
- Artigot Mariano
- Arturi Alessandro
- Arulappan Nirupama
- Arya Shobhit
- Arynov Ardak
- Asaad Peter
- Asano Yukio
- Ascari Francesca
- Asgarov Mohsum
- Ashmawy Soad
- Aslam Muhammad Imran
- Assimakopoulou Elena
- Assis Ana
- Astilleta Romina
- Atanasov Boyko
- Atendido Tiffany
- Athanasakis Elias
- Atici Semra Demirli
- Avellaneda Nicholas
- Avellaneda Nicolas
- Avseren Goksu
- Awead Marwa
- Ayandipo Omobolaji
- Aybar Engin
- Aydin Funda
- Aydin Gaye
- Ayoub Kusay
- Aytac Erman
- Aytaç Erman
- Azevedo Jose
- Azevedo Patricia
- Azhar Najia
- Aziz Gowhar
- Azman Zairul Azwan Mohd
- Aşkar Ahmet
- Babatunde Olanrewaju
- Badawi Marwa
- Baek Jeong-Heum
- Baez Noelia Fernández
- Baeza-Murcia Melody
- Bagnardi Francesco
- Baharom Salahudin
- Baik Seung Hyuk
- Baimakhanov Abylai
- Bains Lovenish
- Baker Aleksandra
- Bakmaz Bernarda
- Bala Abubakar Muhammad
- Balaban Vladimir
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- Balasubramaniam Dinesh
- Balathayalan Yathev
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- Balfour James
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- Baloyiannis Ioannis
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- Bandar Mahdi Al
- Banham Gail
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- Barbosa Anderson
- Bareka Metaxia
- Baris Baver
- Barradas Renato
- Barreda Sara Castillo
- Barrena-Blazquez Silvestra
- Barton Jess
- Bartosiak Katarzyna
- Bashilkina Olga
- Bashir Mohammed
- Basile Raffaele
- Basnyat Pradeep
- Batool Sana
- Bautista Wilson Manuel Sánchez
- Bayhan Zülfü
- Bayo José Manuel Muros
- Bayón Raquel Álvaro
- Baños Pedro Antonio Parra
- Beard David
- Bedzhanyan Arkady
- Behilil Chakib
- Bekele Kebebe
- Belarmino Armin
- Belay Million
- Belev Nikolay
- Bellato Vittoria
- Beltrán de Heredia Juan
- Belvedere Angela
- Benetti Emilio
- Benetti Sara
- Bengueddach Aicha
- Benjelloun El Bachir
- Benkabbou Amine
- Bennett James
- Bensafir Salim
- Bergamini Carlo
- Bernotaite Vlada
- Beron Reinaldo Isaacs
- Bethune Robert
- Bezede Cosmin
- Beznosenko Andriy
- Bhangu Aneel
- Bhargava Aman
- Bhat Rama Rani Krishna
- Bianchi Romina
- Bianco Francesco
- Bigoni Irene
- Binetti Margherita
- Bintintan Vasile
- Biondi Alberto
- Biondo Santino Antonio
- Bisgin Tayfun
- Bisheet George
- Bissett Ian
- Biswas Jyotirmoy
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- Yoldas Tayfun
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- Yoshino Kenji
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- Zaari Fatimazahraa
- Zabiyaka Mikhail
- Zadrożna Monika
- Zafar Madiha
- Zagaynov Eugeny
- Zaidi Syed-Nadeem
- Zaimis Tilemachos
- Zain Wan Zainira Wan
- Zainy Rhendra Hardy Mohamad
- Zakaria Andee Dzulkarnaen
- Zakaria Maheen
- Zakaria Zaidi
- Zamudio-Bautista Jorge Luis
- Zanc Loredana
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- Zanus Giacomo
- Zapparoli Alessandro
- Zappone Anna
- Zarzava Eirini
- Zatari Dirar
- Zawadzki Marek
- Zayakov Georgi
- Zaycev Andrey
- Zazo Aya
- Zazo Rama
- Zdravkovic Maja
- Zengin Abdullah Kağan
- Zeringa Georgia
- Zimmerman David D E
- Zuhdy Mohammad
- Zvirych Vitalii
- Zywicka Ewa
- Álvarez-Llano Laura
- Ângelo Miguel Duarte
- ÓSullivan Sara Nuñez
- Özçelik Mehmet Faik
- Ćoza Ivo
- Şanlı Ahmet Necati
- Publication venue
- Publication date
- 01/01/2023
- Field of study
Background
Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.
Methods
The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.
Results
A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).
Conclusion
Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)