Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background 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

Abatement of ammonia and butyraldehyde under non-thermal plasma and photocatalysis Oxidation processes for the removal of mixture pollutants at pilot scale

International audienceDielectric barrier discharge DBD-plasma based technologies have been widely investigated for the abatement of air pollutants. More recently, photocatalysis (TiO2/UV-lamp) has also showed promising results for air pollution abatement. In this work, these two methods were used separately and combined (TiO2/UV-lamp/DBD-plasma) in order to enhance the performance of the process for air pollutants degradation/mineralization. Ammonia (NH3) and butyraldehyde (C4H8O) have been firstly treated alone and then an equimolar mixture (NH3/C4H8O) was monitored in a continuous reactor. Effect of operational parameters such as pollutants inlet concentration, flowrate, humidity and specific energy of plasma were thoroughly determined. Results showed that coupling both methods in the same reactor improves removal efficiency for single pollutant or a mixture of two pollutants. This processes combination showed a synergy between DBD-plasma and photocatalytic oxidation. Moreover, pollutant mineralization and potential intermediate byproducts have been characterized and discussed. Coupling both processes contributes to enhanced mineralization in comparison with DBD-plasma alone regarding the CO2 selectivity. As for selectivity of byproducts (i) Relative Humidity (RH), (ii) mixture effect and (iii) (TiO2/UV-lamp/DBD-plasma) combined processes inhibit ozone production during the pollutants removal/oxidation

Dynamics of VOCs degradation and bacterial inactivation at the interface of AgxO/Ag/TiO2 prepared by HiPIMS under indoor light

International audienceAgxO/Ag/TiO2 photoactive thin films were produced by different modes of magnetron sputtering (namely, DCMS and HiPIMS). The spectral and microstructural properties of the Ag-AgxO/TiO2 thin films were studied by Diffuse Reflection Spectroscopy (DRS) and X-ray Photoemission Spectroscopy (XPS). The atomic deposition of TiO2 and Ag in the thin sputtered film were studied by TEM. AgxO/Ag/TiO2 exhibited fast photocatalytic volatile organic compounds (VOCs) degradation and bacterial inactivation under low visible light intensity. The Langmuir Hinshelwood model was applied to highlight the photocatalytic performance of the AgxO/Ag/TiO2 catalyst. The oxidative states of Ag-AgxO/TiO2 were studied by XPS. Deconvolution of the Ag3d peak of the AgxO/Ag/TiO2 thin films showed the presence of AgO and metallic Ag. It is suggested that the mechanism involving the degradation of VOCs on AgO/Ag/TiO2 catalysts is due to the transfer of holes from AgO to TiO2 via the AgO/Ag/ TiO2 heterojunction. The electrostatic interaction between both semiconductors allows this charge transfer. In addition, the contribution of reactive oxygen species (ROS) in bacterial inactivation at the interface of AgO/Ag/ TiO2 thin film was also examined. Light-induced interfacial charge transfer (IFCT) between AgO and TiO2 leading to pollutants oxidation appears to require low photons' energy and can oxidize pollutants even at high concentrations. The sputtered coatings have also been studied for repetitive reuse, showing the sustainable activity of the prepared materials

Integrated process for the removal of indoor VOCs from food industry manufacturing Elimination of Butane-2,3-dione and Heptan-2-one by cold plasma-photocatalysis combination

International audienceCoupling Non-thermal plasma (dielectric barrier discharge) with photocatalysis (TiO2-/UV) can be a promising technique to improve indoor air quality. In this study, Butane-2,3-dione and Heptan-2-one, usually found in food industry, were used as target compounds. Firstly, each pollutant was studied alone by photocatalytic treatment under experimental parameter effects like gases flow rate, VOCs inlet concentration, and humidity levels. Otherwise, in order to understand pollutants reaction mechanisms, a complex composition mixture was then studied and discussed. Experiments with dry and wet air showed good Heptan-2-one removal but negatively affected Butane-2,3-dione elimination rate. The Butane-2,3-dione/Heptan-2-one oxidation study was carried out by cold plasma-photocatalysis combination in the same pilot reactor. Excellent treatment yields were observed in terms of pollutant removal efficiency, mineralization and Ozone decomposition. Additionally, intermediate by-product exhausts from three technologies e.g. TiO2/UV-light system, DBD-plasma and their combination are identified

Innovative photocatalytic reactor for the degradation of VOCs and microorganism under simulated indoor air conditions: Cu-Ag/TiO2-based optical fibers at a pilot scale

International audienceThis study deals with photocatalytic application for indoor air pollution remediation. Two target compounds were selected: Butane-2,3-dione (C4H6O2) and Heptan-2-one (C7H14O). Escherichia coli (E. coli) were used as bacteria strain. Photocatalytic removal of VOCs alone, E. coli alone and their mixture (VOCs/E. coli) were evaluated, at pilot scale. Indeed, a series of experiments were carried out in a continuous planar reactor using a novel photocatalyst/TiO2 technology with metal wires e.g. Copper (Cu)/Silver (Ag)-woven in optical fiber. Effects of experimental conditions such as flow rate (2–12 m3.h−1), VOCs inlet concentration (5–20 mg.m−3) and humidity levels (5–70%) on removal efficiency were investigated to properly appraise the oxidation performance in real conditions. All textile fiber photo-catalysts (TiO2, TiO2-Cu and TiO2-Ag) showed good photocatalytic activities towards C4H6O2/C7H14O removal. As for simultaneous application with VOCs and E. coli: (i) in terms of VOCs removal efficiency, the same trend of performance was observed compared to VOCs experiments alone: 63% of removal efficiency by TiO2 alone, 46% by TiO2-Ag and 52% by TiO2-Cu, (ii) in terms of E. coli inactivation, only experiments with TiO2-Cu and TiO2-Ag revealed a good performanc

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 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

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