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

Abiotic and Biotic Stresses Interaction in Fabaceae Plants. Contributions from the Grain Legumes/Soilborne Vascular Diseases/Drought Stress Triangle

Editors: Mirza Hasanuzzaman, Susana Araújo, Sarvajeet Singh Gill.As sessile organisms, plants are constantly exposed to simultaneously abiotic and biotic stresses that impact growth thus resulting in significant yield losses. An example is drought and root infecting pathogens, which combined cause greater damage to plants than the stresses individually. Substantial information is available on the physiological, molecular, and metabolic changes in Fabaceae plants exposed to individual stresses, but little is known about how plants respond to multiple stresses. This is of primary importance for the development of breeding approaches based on the trade-off between plant defense response mechanisms, and high and consistent yield under field conditions. A better knowledge of the mechanisms by which legume plants perceive and transduce simultaneous or sequential combination of stress signals to initiate diverse adaptive responses is essential for breeding multiple stress-tolerant crop cultivars. In this chapter, we assess the relevance of understanding legume combined responses to abiotic and biotic stresses for production and breeding, focusing on soilborne vascular diseases and drought interaction in grain legumes. Particular attention is given to the crosstalk between signaling pathways of the “stress triangle” pathogen/host/environment interactions and to the application of integrated breeding methods aiming at multiple stress-resistant legume crops better adapted to climate change.Financial support by Fundação para a Ciência e Tecnologia (FCT), Portugal, is acknowledged through grant SFRH/BD/92160/2013 (STL), DL57 PhD holder contract (SA), IF/01337/2014 FCT Investigator contract (MCVP), research project BeGeQA (PTDC/AGR-TEC/3555/2012) and research unit GREEN-IT “Bioresources for Sustainability” (UID/Multi/04551/2019)

Kuluttajabarometri maakunnittain 2000, 2. neljännes

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