5 research outputs found
Mortality of emergency abdominal surgery in high-, middle- and low-income countries
Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).
Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.
Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1â
6 per cent at 24 h (high 1â
1 per cent, middle 1â
9 per cent, low 3â
4 per cent; P < 0â
001), increasing to 5â
4 per cent by 30 days (high 4â
5 per cent, middle 6â
0 per cent, low 8â
6 per cent; P < 0â
001). Of the 578 patients who died, 404 (69â
9 per cent) did so between 24 h and 30 days following surgery (high 74â
2 per cent, middle 68â
8 per cent, low 60â
5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2â
78, 95 per cent c.i. 1â
84 to 4â
20) and low-income (OR 2â
97, 1â
84 to 4â
81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days.
Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)
Behçetâs disease physiopathology: a contemporary review
International audienceBehçetâs disease, also known as the Silk Road Disease, is a rare systemic vasculitis disorder of unknown etiology. Recurrent attacks of acute inflammation characterize Behçetâs disease. Frequent oral aphthous ulcers, genital ulcers, skin lesions and ocular lesions are the most common manifestations. Inflammation is typically self-limiting in time and relapsing episodes of clinical manifestations represent a hallmark of Behçetâs disease. Other less frequent yet severe manifestations that have a major prognostic impact involve the eyes, the central nervous system, the main large vessels and the gastrointestinal tract. Behçetâs disease has a heterogeneous onset and is associated with significant morbidity and premature mortality. This study presents a current immunological review of the disease and provides a synopsis of clinical aspects and treatment options