Domain and Geometry Agnostic CNNs for Left Atrium Segmentation in 3D Ultrasound

Segmentation of the left atrium and deriving its size can help to predict and detect various cardiovascular conditions. Automation of this process in 3D Ultrasound image data is desirable, since manual delineations are time-consuming, challenging and observer-dependent. Convolutional neural networks have made improvements in computer vision and in medical image analysis. They have successfully been applied to segmentation tasks and were extended to work on volumetric data. In this paper we introduce a combined deep-learning based approach on volumetric segmentation in Ultrasound acquisitions with incorporation of prior knowledge about left atrial shape and imaging device. The results show, that including a shape prior helps the domain adaptation and the accuracy of segmentation is further increased with adversarial learning

Intellectual Impairment in School-Age Children Exposed to Manganese from Drinking Water

ABSTRACT: BACKGROUND: Manganese is an essential nutrient, but in excess it can be a potent neurotoxicant. Despite the common occurrence of manganese in groundwater, the risks associated with this source of exposure are largely unknown. OBJECTIVES: Our first aim was to assess the relations between exposure to manganese from drinking water and children's intelligence quotient (IQ). Second, we examined the relations between manganese exposures from water consumption and from the diet with children's hair manganese concentration. METHODS: This cross-sectional study included 362 children 6-13 years of age living in communities supplied by groundwater. Manganese concentration was measured in home tap water (MnW) and children's hair (MnH). We estimated manganese intake from water ingestion and the diet using a food frequency questionnaire and assessed IQ with the Wechsler Abbreviated Scale of Intelligence. RESULTS: The median MnW in children's home tap water was 34 microg/L (range, 1-2,700 microg/L). MnH increased with manganese intake from water consumption, but not with dietary manganese intake. Higher MnW and MnH were significantly associated with lower IQ scores. A 10-fold increase in MnW was associated with a decrease of 2.4 IQ points (95% confidence interval: -3.9 to -0.9; p < 0.01), adjusting for maternal intelligence, family income, and other potential confounders. There was a 6.2-point difference in IQ between children in the lowest and highest MnW quintiles. MnW was more strongly associated with Performance IQ than Verbal IQ. CONCLUSIONS: The findings of this cross-sectional study suggest that exposure to manganese at levels common in groundwater is associated with intellectual impairment in children

age: Observational data from the ICON audit

Purpose: To investigate age-related differences in outcomes of critically ill patients with sepsis around the world.Methods: We performed a secondary analysis of data from the prospective ICON audit, in which all adult ( >16 years ) patients admitted to participating ICUs between May 8 and 18, 2012, were included, except admissions for routine postoperative observation. For this sub-analysis, the 10,012 patients with completed age data were included. They were divided into five age groups - 80 years. Sepsis was defined as infection plus at least one organ failure.Results: A total of 2963 patients had sepsis, with similar proportions across the age groups (80 = 30.9%). Hospital mortality increased with age and in patients >80 years was almost twice that of patients 70 years was independently associated with increased risk of dying.Conclusions: The odds for death in ICU patients with sepsis increased with age with the maximal rate of increase occurring between the ages of 71 and 77 years. (C) 2019 Elsevier Inc. All rights reserved.C1 [Kotfis, Katarzyna] Pomeranian Med Univ, Dept Anaesthesiol Intens Therapy & Acute Intoxica, Szczecin, Poland.[Wittebole, Xavier] UCL, Clin Univ St Luc, Dept Crit Care, Brussels, Belgium.[Jaschinski, Ulrich] Klinikum Augsburg, Klin Anasthesiol & Operat Intens Med, Augsburg, Germany.[Sole-Violan, Jordi] Hosp Univ Gran Canaria Dr Negrin, Dept Intens Care, Las Palmas Gran Canaria, Spain.[Kashyap, Rahul] Mayo Clin, Dept Anesthesia Ei Perioperat Med, Rochester, MN USA.[Leone, Marc] Aix Marseille Univ, Hop Nord, AP HM, Serv Anesthesie & Reanimat, Marseille, France.[Nanchal, Rahul] Med Coll Wisconsin, Dept Med, Milwaukee, WI 53226 USA.[Fontes, Luis E.] Hosp Alcides Carneiro, Petropolis Med Sch, Dept Intens Care & Evidence Based Med, Petropolis, Brazil.[Sakr, Yasser] Uniklinikum Jena, Dept Anesthesiol & Intens Care, Jena, Germany.[Vincent, Jean-Louis] Univ Libre Bruxelles, Erasme Univ Hosp, Dept Intens Care, Route Lenn 808, B-1070 Brussels, Belgium.[Tomas, E.] Clin Sagrada Esperanca, Luanda, Angola.[Bibonge, E. Amisi] Clin Univ Kinshasa, Kinshasa, DEM REP CONGO.[Charra, B.] Chu Ibn Rochd Casablanca, Casablanca, Morocco.[Faroudy, M.] Ibn Sina Hosp, Rabat, Morocco.[Doedens, L.] Chris Hani Baragwanath Acad Hosp, Soweto, South Africa.[Farina, Z.] Grays Hosp, Pietermaritzburg, South Africa.[Adler, D.] Sandton Medi Clin, Sandton, South Africa.[Balkema, C.] Tygerberg Hosp, Cape Town, South Africa.[Kok, A.] Union Hosp Alberton, Alberton, South Africa.[Alaya, S.] Bizerte Hosp, Bizerte, Tunisia.[Gharsallah, H.] Mil Hosp Tunis, Tunis, Tunisia.[Muzha, D.] Natl Trauma Ctr & Mil Hosp, Tirana, Albania.[Temelkov, A.] Alexandrovska Univ Hosp, Sofia, Bulgaria.[Georgiev, G.] Emergency Univ Hosp Pirogov, Sofia, Bulgaria.[Simeonov, G.] Tokuda Hosp Sofia, Sofia, Bulgaria.[Tsaryanski, G.] Uh St Ekaterina Sofia, Sofia, Bulgaria.[Georgiev, S.] Univ Hosp Obstet & Gynaecol, Sofia, Bulgaria.[Seliman, A.] Univ Hosp Sveta Marina Varna, Varna, Bulgaria.[Vrankovic, S.] Gen Hosp Siben, Shibenik, Croatia.[Vucicevic, Z.] Univ Hosp Ctr Sestre Milosrdnice, Zagreb, Croatia.[Gornik, I] Univ Hosp Ctr Zagreb, Zagreb, Croatia.[Barsic, B.] Univ Hosp Infect Dis, Zagreb, Croatia.[Husedzinovic, I] Univ Hosp Dubrava, Zagreb, Croatia.[Pavlik, P.] Ctr Cardiovasc & Transplant Surg, Prague, Czech Republic.[Manak, J.] Charles Univ Hosp, Prague, Czech Republic.[Kieslichova, E.] IKEM, Prague, Czech Republic.[Turek, R.] KNTB Zlin AS, Prague, Czech Republic.[Fischer, M.] Krajska Nemocnice Liberec, Prague, Czech Republic.[Valkova, R.] Masarykova Nemocnice V Usti Labem, Labem, Czech Republic.[Dadak, L.] St Annes Univ Hosp Brno, Brno, Czech Republic.[Dostal, P.] Univ Hosp Haradec Kralove, Haradec Kralove, Czech Republic.[Malaska, J.] Univ Hosp Brno, Brno, Czech Republic.[Hajek, R.] Univ Hosp Olomouc, Olomouc, Czech Republic.[Zidkova, A.] Univ Hosp Plzen, Plzen, Czech Republic.[Lavicka, P.] Charles Univ Hosp Plzen, Plzen, Czech Republic.[Starkopf, J.] Tartu Univ Hosp, Tartu, Estonia.[Kheladze, Z.] Crit Care Med Inst, Gainesville, Georgia.[Chkhaidze, M.] Jo Ann Med Ctr, Tbilisi, Georgia.[Kaloiani, V] Kipshidze Cent Univ Hosp, Tbilisi, Georgia.[Medve, L.] Dr Kenessey Albert Hosp, Balassagyarmat, Hungary.[Sarkany, A.] Fejer Cty St George Teaching Hosp, Szekesfehervar, Hungary.[Kremer, I] Flor Ferenc Cty Hosp, Budapest, Hungary.[Marjanek, Z.] Javorszky Odon Hosp, Vac, Hungary.[Tamasi, P.] Peterfy Hosp Budapest, Budapest, Hungary.[Krupnova, I] Infectol Ctr Latvia, Riga, Latvia.[Vanags, I] Paul Stradins Clin Univ Hosp, Riga, Latvia.[Liguts, V] Riga East Clin Univ Hosp, Riga, Latvia.[Pilvinis, V] Hosp Lithuanian Univ Hlth Sci Kauno Klinikos, Kaunas, Lithuania.[Vosylius, S.] Vilnius Univ Hosp, Vilnius, Lithuania.[Kekstas, G.] HSICU, Vilnius Univ Hosp Santariskiu Clin, Vilnius, Lithuania.[Balciunas, M.] CICU, Vilnius Univ Hosp Santariskiu Clin, Vilnius, Lithuania.[Kolbusz, A.] Csk Mswia, Warsaw, Poland.[Kubler, A.] Med Univ, Wroclaw, Poland.[Mielczarek, B.] Med Univ Wroclaw, Wroclaw, Poland.[Mikaszewska-Sokolewicz, M.] Med Univ Warsaw, Warsaw, Poland.[Kotfis, K.] Pomeranian Med Univ, Szczecin, Poland.[Tamowicz, B.] Reg Hosp Poznan, Poznan, Poland.[Sulkowski, W.] Szpital Powiatowy W Ostrowi Mazowieckiej, Ostrow Mazowiecka, Poland.[Smuszkiewicz, P.] Univ Hosp, Poznan, Poland.[Pihowicz, A.] Wojewodzki Szpital Zakazny, Torun, Poland.[Trejnowska, E.] Wojewodzkie Ctr Med, Warsaw, Poland.[Hagau, N.] Emergency Cty Hosp Cluj, Cluj Napoca, Romania.[Filipescu, D.] Emergency Inst Cardiovasc Dis, Bucharest, Romania.[Droc, G.] Fundeni Clin Inst, Bucharest, Romania.[Lupu, M.] Galati Hosp, Bucharest, Romania.[Nica, A.] Lnbi Prof Dr Matei Bals, Bucharest, Romania.[Stoica, R.] Inst Pulmonol Marius Nasta, Bucharest, Romania.[Tomescu, D.] Inst Clin Fundeni, Bucharest, Romania.[Constantinescu, D.] Sfantul Pantelimon Hosp, Bucharest, Romania.[Zbaganu, G. Valcoreanu] Spitalul Cf 2 Bucuresti, Bucharest, Romania.[Slavcovici, A.] Iuliu Hatieganu Univ Med & Pharm, Teaching Hosp Infect Dis, Cluj Napoca, Romania.[Bagin, V] City Clin Hosp 40, St Petersburg, Russia.[Belsky, D.] City Hosp 40, St Petersburg, Russia.[Palyutin, S.] Clin Hosp NVNV Solovyev, Yaroslavl, Russia.[Shlyapnikov, S.] Emergency Res Inst NA Djanelidze, St Petersburg, Russia.[Bikkulova, D.] Fed Res Ctr Paediat Haematol Oncol & Immunol, Moscow, Russia.[Gritsan, A.] Krasnoyarsk State Med Univ, Krasnoyarsk Reg Hosp, Krasnoyarsk, Russia.[Natalia, G.] Med Assoc Novaya Bolnitsa, Ekaterinburg, Russia.[Makarenko, E.] Mil Med Acad, Ekaterinburg, Russia.[Kokhno, V] Novosibirsk Med Univ, Novosibirsk, Russia.[Tolkach, A.] Omsk Reg Clin Hosp, Omsk, Russia.[Kokarev, E.] Railway Hosp Khabarovsk, Khabarovsk, Russia.[Belotserkovskiy, B.] St Alexy Hosp, St Louis, France.[Zolotukhin, K.] State Dist Hosp, Moscow, Russia.[Kulabukhov, V] Vishnevsky Inst Surg, Moscow, Russia.[Soskic, L.] Clin Ctr Serbia, Clin Cardiac Surg, Belgrade, Serbia.[Palibrk, I] Clin Ctr Serbia, Clin Digest Surg, Belgrade, Serbia.[Jankovic, R.; Jovanovic, B.] Clin Ctr Nis, Clin Vasc Surg, Nish, Serbia.[Pandurovic, M.] Clin Ctr Serbia, Emergency Ctr, Belgrade, Serbia.[Bumbasirevic, V] Clin Ctr Belgrade, Emergency Ctr, Belgrade, Serbia.[Uljarevic, B.] Gen Univ Hosp, Belgrade, Serbia.[Surbatovic, M.] Mil Med Acad, Belgrade, Serbia.[Ladjevic, N.] Urol Hosp, Belgrade, Serbia.[Slobodianiuk, G.] Dist Hosp, Bratislava, Slovakia.[Sobona, V] Fac Hosp, Bratislava, Slovakia.[Cikova, A.] Univ Hosp Bratislava, Hosp Ruzinov ICU, Bratislava, Slovakia.[Gebhardtova, A.] Univ Hosp Ruzinov Bratislava, Bratislava, Slovakia.[Jun, C.] Qingdao Univ, Tertiary Hosp, Qingdao, Shandong, Peoples R China.[Yunbo, S.] Qingdao Univ, Affiliated Hosp, Med Coll, Qingdao, Shandong, Peoples R China.[Dong, U.] Beijing Canc Hosp, Beijing Inst Canc Res, Beijing, Peoples R China.[Feng, S.] Beijing Chaoyang Hosp, Beijing, Peoples R China.[Duan, M.] Beijing Friendship Hosp, Beijing, Peoples R China.[Xu, Y.] Capital Med Univ, Beijing Tongren Hosp, Beijing, Peoples R China.[Xue, X.] Beijing Univ Peoples Hosp, Beijing, Peoples R China.[Gao, T.] Beijing Luhe Hosp, Beijing, Peoples R China.[Xing, X.] Chinese Acad Med Sci, Canc Hosp, Beijing, Peoples R China.[Zhao, X.] China Acad Chinese Med Sci, Guang An Men Hosp, Beijing, Peoples R China.[Li, C.] Peoples Hosp, Chuxiong, Yunnan, Peoples R China.[Gengxihua, G.] Donge Cty Peoples Hosp Shandong Prov, Liaocheng, Shandong, Peoples R China.[Tan, H.] Chinese Acad Med Sci, Fu Wai Hosp, Beijing, Peoples R China.[Xu, J.] Fujian Prov Hosp, Fuzhou, Fujian, Peoples R China.[Jiang, L.] Capital Med Univ, Fuxing Hosp, Beijing, Peoples R China.[Tiehe, Q.] Guangdong Gen Hosp, Guangzhou, Guangdong, Peoples R China.[Bingyu, Q.] Henan Prov Peoples Hosp, Zhengzhou, Henan, Peoples R China.[Shi, Q.] Xi An Jiao Tong Univ, Coll Med, Xian, Shaanxi, Peoples R China.[Lv, Z.] Kunming Third Peoples Hosp, Kunming, Yunnan, Peoples R China.[Zhang, L.] Lanzhou Univ, Hosp 2, Lanzhou, Gansu, Peoples R China.[Jingtao, L.] 309th Hosp, Beijing, Peoples R China.[Zhen, Z.] China Med Univ, Hosp 1, Beijing, Peoples R China.[Wang, Z.] Peking Univ, Shougang Hosp, Beijing, Peoples R China.[Wang, T.] Peking Univ, Hosp 3, Beijing, Peoples R China.[Yuhong, L.] Pla Navy Gen Hosp, Beijing, Peoples R China.[Zhai, Q.] Shandong Univ, Qilu Hosp, Jinan, Shandong, Peoples R China.[Chen, Y.] Jiaotong Univ, Affiliated Med Sch, Ruijin Hosp, Shanghai, Peoples R China.[Wang, C.] Shandong Prov Hosp, Jinan, Shandong, Peoples R China.[Jiang, W.] Shanghai 10th Peoples Hosp, Shanghai, Peoples R China.[Ruilan, W.] Shanghai First Peoples Hosp, Shanghai, Peoples R China.[Chen, Y.; Xiaobo, H.] Sichuan Prov Peoples Hosp, Chengdu, Sichuan, Peoples R China.[Ge, H.] Sir Run Run Shaw Hosp, Hangzhou, Zhejiang, Peoples R China.[Yan, T.] Affiliated Guiyang Med Coll, Guiyang, Guizhou, Peoples R China.[Yuhui, C.] Fudan Univ, Peoples Hosp Shanghai 5, Shanghai, Peoples R China.[Zhang, J.] Dalian Med Univ, Affiliated Hosp 1, Dalian, Peoples R China.[Jian-Hong, F.] Suzhou Univ, Affiliated Hosp 1, Suzhou, Peoples R China.[Zhu, H.] Xinjiang Med Univ, Affiliated Hosp 1, Urumqi, Peoples R China.[Huo, F.; Wang, Y.] Jilin Univ, Hosp 1, Changchun, Jilin, Peoples R China.[Li, C.] First Peoples Hosp Kunming, Kunming, Yunnan, Peoples R China.[Zhuang, M.] Gen Hosp Shenyang Mil Reg, Shenyang, Liaoning, Peoples R China.[Ma, Z.] Peoples Hosp Cangzhou, Cangzhou, Peoples R China.[Sun, J.] Jilin Univ, Hosp 2, Changchun, Jilin, Peoples R China.[Liuqingyue, L.] Second Peoples Hosp Liaocheng City Shandong Prov, Liaocheng, Shandong, Peoples R China.[Yang, M.] Third Xiangya Hosp, Changsha, Hunan, Peoples R China.[Meng, J.] Tongde Hosp Zhejiang Prov, Hangzhou, Zhejiang, Peoples R China.[Ma, S.] Tongji Univ, Shanghai East Hosp, Shanghai, Peoples R China.[Kang, Y.] West China Hosp, Scu, Peoples R China.[Yu, L.] Wuhan Ctr Hosp, Wuhan, Hubei, Peoples R China.[Peng, Q.] Xiangya Hosp, Changsha, Hunan, Peoples R China.[Wei, Y.] Yantai Yuhuangding Hosp, Yantai, Peoples R China.[Zhang, W.] Yantaishan Hosp, Yantai, Shandong, Peoples R China.[Sun, R.] Zhejiang Prov Peoples Hosp, Hangzhou, Zhejiang, Peoples R China.[Yeung, A.] Pamela Youde Nethersole Eastern Hosp, Hong Kong, Peoples R China.[Wan, W.] Princess Margaret Hosp, Hong Kong, Peoples R China.[Sin, K.] Queen Elizabeth Hosp, Hong Kong, Peoples R China.[Lee, K.] United Christian Hosp Hong Kong SAR, Hong Kong, Peoples R China.[Wijanti, M.] Anestesi, Yogyakarta, Indonesia.[Widodo, U.] Pku Muhammadiyah Bantu, Yogyakarta, Indonesia.[Samsirun, H.] Rd Mattaher Hosp Jambi, Jambi City, Indonesia.[Sugiman, T.] Rumah Sakit Pantai Lndah Kapuk, North Jakarta, Indonesia.[Wisudarti, C.] Sardjito Hosp, Yogyakarta, Indonesia.[Maskoen, T.] Sch Med Unpad, Hasan Sadikin Hosp, Bandung, Indonesia.[Hata, N.] Nippon Med Sch, Chiba Hokusoh Hosp, Inzai, Japan.[Kobe, Y.] Chiba Univ Hosp, Chiba, Japan.[Nishida, O.] Fujita Hlth Univ, Sch Med, Toyoake, Aichi, Japan.[Miyazaki, D.] Japanese Red Cross Maebashi Hosp, Maebashi, Gumma, Japan.[Nunomiya, S.] Jichi Med Univ Hosp, Shimotsuke, Japan.[Uchino, S.] Jikei Univ, Sch Med, Tokyo, Japan.[Kitamura, N.] Kimitsu Chuo Hosp, Kisarazu, Japan.[Yamashita, K.] Kochi Med Sch, Nankoku, Kochi, Japan.[Hashimoto, S.] Kyoto Prefectural Univ Med, Kyoto, Japan.[Fukushima, H.] Nara Med Univ Hosp, Kashihara, Nara, Japan.[Adib, N. Nik] Hosp Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia.[Tai, L.] Kuala Lumpur Hosp, Kuala Lumpur, Malaysia.[Tony, B.] Queen Elizabeth Hosp 2, Kota Kinabalu, Malaysia.[Bigornia, R.] Cebu Velez Gen Hosp, Cebu, Philippines.[Bigornia, R.] Perpetual Succour Hosp, Cebu, Philippines.[Palo, J.] Med City, Pasig, Philippines.[Chatterjee, S.] Alexandra Hosp, Singapore, Singapore.[Tan, B.] Natl Univ Hlth Syst, Singapore, Singapore.[Kong, A.] Singapore Gen Hosp, Singapore, Singapore.[Goh, S.] Tan Tock Seng Hosp, Singapore, Singapore.[Lee, C.] Natl Taiwan Univ Hosp, Taipei, Taiwan.[Pothirat, C.] Chiaingmai Univ, Maharaj Nakorn Chiangmai Hosp, Chiang Mai, Thailand.[Khwannimit, B.] Prince Songkla Univ, Hat Yai, Thailand.[Theerawit, P.] Ramathibodi Hosp, Bangkok, Thailand.[Pornsuriyasak, P.] Ramathibodi Hosp, Somdech Phra Debaratana Med Ctr, Bangkok, Thailand.[Piriyapatsom, A.] Mahidol Univ, Siriraj Hosp, Bangkok, Thailand.[Mukhtar, A.] Cairo Univ, Giza, Egypt.[Dsicu] Demerdash Surg Intens Care Unit, Cairo, Egypt.[Hamdy, A. Nabil] Ain Shams Fac Med, Cairo, Egypt.[Hosny, H.] Zaitoun Specialized Hosp, Cairo, Egypt.[Ashraf, A.] Gums, Tehran, Iran.[Mokhtari, M.] Sbums, Imam Hossein Hosp, Tehran, Iran.[Nowruzinia, S.] Imamreza Hosp, Mashhad, Razavi Khorasan, Iran.[Lotfi, A.] Laleh Hosp, Tehran, Iran.[Zand, F.] Shiraz Anesthesiol & Crit Care Res Ctr, Shiraz, Iran.[Nikandish, R.] Shiraz Univ Med Sci, Shiraz, Iran.[Moghaddam, O. Moradi] Tehran Med Sci Univ, Tehran, Iran.[Cohen, J.] Rabin Med Ctr, Petah Tiqwa, Israel.[Sold, O.] Sourasky Tel Aviv Med Ctr, Tel Aviv, Israel.[Sfeir, T.] Ctr Hosp Nord, Ettelbruck, Luxembourg.[Hasan, A.] Sohar Hosp, Sohar, Oman.[Abugaber, D.] Specialized Arab Hosp, Nablus, Palestine.[Ahmad, H.] Almana Gen Hosp, Khobar, Saudi Arabia.[Tantawy, T.] KFSHRC, Riyadh, Saudi Arabia.[Baharoom, S.] King Abdulaziz Med City Riyadh, Riyadh, Saudi Arabia.[Algethamy, H.] King Abdulaziz Univ, Jeddah, Saudi Arabia.[Amr, A.] King Saud Med City, Riyadh, Saudi Arabia.[Almekhlafi, G.] Riyadh Mil Hosp, Riyadh, Saudi Arabia.[Coskun, R.] Erciyes Univ, Med Fac, Kayseri, Turkey.[Sungur, M.] Erciyes Univ, Med Sch, Kayseri, Turkey.[Cosar, A.] Gulhane Mil Med Acad, Ankara, Turkey.[Gucyetmez, B.] Int Hosp, Istanbul, Turkey.[Demirkiran, O.] Istanbul Univ, Cerrahpasa Med Sch Hosp, Istanbul, Turkey.[Senturk, E.] Istanbul Univ, Istanbul Med Fac, Istanbul, Turkey.[Ulusoy, H.] Karadeniz Tech Univ, Med Fac, Trabzon, Turkey.[Atalan, H.] Mem Atasehir Hosp, Istanbul, Turkey.[Serin, S.] Pamukkale Univ, Denizli, Turkey.[Kati, I] Yuzuncu Yil Univ, Med Fac, Van, Turkey.[Alnassrawi, Z.] Dubai Hosp, Dubai, U Arab Emirates.[Almemari, A.] Mafraq Hosp, Abu Dhabi, U Arab Emirates.[Krishnareddy, K.] Sheikh Khalifa Med City, Abu Dhabi, U Arab Emirates.[Kashef, S.] Tawam Hosp, Al Ain, U Arab Emirates.[Alsabbah, A.] City Hosp, Dubai, U Arab Emirates.[Poirier, G.] Hop Charles Lemoyne, Longueuil, PQ, Canada.[Marshall, J.] St Michaels Hosp, Toronto, ON, Canada.[Herridge, M.] Toronto Gen Hosp, Toronto, ON, Canada.[Herridge, M.] Toronto Western Hosp, Toronto, ON, Canada.[Fernandez-Medero, R.] San Juan Hosp, San Juan, PR USA.[Fulda, G.] Christiana Care Hlth Syst, Newark, DE USA.[Banschbach, S.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA.[Quintero, J.] El Camino Hosp, Mountain View, CA USA.[Schroeder, E.] George Washington Hosp, Washington, DC USA.[Sicoutris, C.] Hosp Univ Penn, Philadelphia, PA 19104 USA.[Gueret, R.] John H Stroger Hosp Cook Cty, Chicago, IL USA.[Kashyap, R.] Mayo Clin, CCM, Rochester, MN USA.[Bauer, P.] Mayo Clin, PCC, Rochester, MN USA.[Nanchal, R.] Med Coll Wisconsin, Milwaukee, WI 53226 USA.[Wunderink, R.] Northwestern Mem Hosp, Chicago, IL 60611 USA.[Jimenez, E.] Orlando Reg Med Ctr Inc, Orlando, FL USA.[Ryan, A.] Washington Hosp Ctr, Washington, DC 20010 USA.[Ryan, A.] Washington Hosp Ctr, 2H, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, 2G, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, 3H, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, 3G, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, 4H, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, CVRR, Washington, DC USA.[Prince, D.] Armadale Hlth Serv, Mount Nasura, WA, Australia.[Edington, J.] Bendigo Hosp, Bendigo, Vic, Australia.[Van Haren, F.] Canberra Hosp, Canberra, ACT, Australia.[Bersten, A.] Flinders Med Ctr, Bedford Pk, SA, Australia.[Hawkins, D. J.] Joondalup Hlth Campus, Joondalup, WA, Australia.[Kilminster, M.] Lismore Base Hosp, Lismore, NSW, Australia.[Sturgess, D.] Mater Adult Hosp, South Brisbane, Qld, Australia.[Ziegenfuss, M.] Prince Charles Hosp, Brisbane, Qld, Australia.[O'Connor, S.] Royal Adelaide Hosp, Adelaide, SA, Australia.[Lipman, J.] Royal Brisbane & Womens Hosp, Brisbane, Qld, Australia.[Campbell, L.] Royal Darwin Hosp, Tiwi, NT, Australia.[Mcallister, R.] Royal Hobart Hosp, Hobart, Tas, Australia.[Roberts, B.] Sir Charles Gairdner Hosp, Nedlands, WA, Australia.[Williams, P.] Queen Elizabeth Hosp, Woodville, SA, Australia.[Parke, R.] Auckland Dist Hlth Board, Auckland, New Zealand.[Seigne, P.] Christchurch Hosp, Christchurch, New Zealand.[Freebairn, R.] Hawkes Bay Hosp, Hastings, New Zealand.[Nistor, D.] Palmerston North Hosp, Midcent Hlth, Palmerston North, New Zealand.[Oxley, C.] Middlemore Hosp, Auckland, New Zealand.[Young, P.] Wellington Hosp, Wellington, New Zealand.[Valentini, R.] Cemic, Buenos Aires, DF, Argentina.[Wainsztein, N.] Fleni, Buenos Aires, DF, Argentina.[Comignani, P.] Hosp Aleman, Buenos Aires, DF, Argentina.[Casaretto, M.] Hosp Cent San Isidro, Buenos Aires, DF, Argentina.[Sutton, G.] Hosp Fernandez, Buenos Aires, DF, Argentina.[Villegas, P.] Hosp Francisco Lopez Lima Area Programa Gen Roca, Gen Roca, Argentina.[Galletti, C.] Sanatorio Allende, Cordoba, Argentina.[Neira, J.] Sanatorio Trinidad Palermo, Buenos Aires, DF, Argentina.[Rovira, D.] Sanatorio Julio Corzo Rosario, Rosario, Santa Fe, Argentina.[Hidalgo, J.] Karl Heusner Mem Hosp, Belize City, Belize.[Hidalgo, J.] Belize Healthcare Partner, Belize City, Belize.[Sandi, F.] Hosp Obrero 1, La Paz, Bolivia.[Caser, E.] Cias Unimed Vitoria, Vitoria, ES, Brazil.[Thompson, M.] Evangelical Hosp Cachoeiro De Itapemirim, Cachoeiro De Itapemirim, Brazil.[D'agostino Dias, M.] Hosp 9 Julho, Sao Paulo, Brazil.[Fontes, L.] Hosp Alcides Carneiro, Petropolis, Brazil.[Lunardi, M.] Hosp Clin Luzia De Pinho Melo, Mogi Das Cruzes, Brazil.[Youssef, N.] Hosp Nacoes Curitiba, Curitiba, Parana, Brazil.[Lobo, S.] Hosp Base Famerp, Sao Jose Do Rio Preto, Brazil.[Silva, R.] Hosp Clin Niteroi, Niteroi, RJ, Brazil.[Sales Jr, J.] Hosp Clin Padre Miguel, Rio De Janeiro, Brazil.[Madeira Campos Melo, L.] Hosp Terapia Intens, Sao Paulo, Brazil.[Oliveira, M.] Hosp Trabalhador, Curitiba, Parana, Brazil.[Fonte, M.] Hosp Esperanza, Olinda, PE, Brazil.[Grion, C.] Hosp Evangel Londrina, Londrina, Brazil.[Feijo, C.] Hosp Geral Fortaleza, Fortaleza, Ceara, Brazil.[Rezende, V] Hosp Geral Roraima, Boa Vista, Brazil.[Assuncao, M.] Hosp Israelita Albert Einstein, Sao Paulo, Brazil.[Neves, A.] Hosp Mater Dei, Belo Horizonte, MG, Brazil.[Gusman, P.; Dalcomune, D.] Hosp Meridional, Cariacica, ES, Brazil.[Teixeira, C.] Hosp Moinhos Vento, Porto Alegre, RS, Brazil.[Kaefer, K.] Hosp Municipal Ruth Cardoso, Balneario, Brazil.[Maia, I] Hosp Nereu Ramos, Florianopolis, SC, Brazil.[Souza Dantas, V] Hosp Pasteur, Rio De Janeiro, Brazil.[Costa Filho, R.] Hosp Pro Cardiaco, Rio De Janeiro, Brazil.[Amorim, F.] Hosp Reg Samambaia, Brasilia, DF, Brazil.[Assef, M.] Hosp Reg Hans Dieter Schmidt, Joinville, Brazil.[Schiavetto, P.] Hosp Santa Casa Campo Mourao, Campo Mourao, PR, Brazil.[Houly, J.] Hosp Santa Paula, Sao Paulo, SP, Brazil.[Houly, J.] Hosp Santapaula, Sao Paulo, Brazil.[Bianchi, F.] Hosp Sao Jose Avai, Itaperuna, RJ, Brazil.[Dias, F.] Hosp Sao Lucas Pucrs, Porto Alegre, RS, Brazil.[Avila, C.] Hosp Sao Vicente Paula, Rio De Janeiro, RJ, Brazil.[Gomez, J.] Hosp Sao Vicente Paulo, Rio De Janeiro, Brazil.[Rego, L.] Hosp Saude Mulher, Belem, Para, Brazil.[Castro, P.] Hosp Tacchini, Bento Goncalves, RS, Brazil.[Passos, J.] Hosp Unimed Costa Do Sol Macae Rj, Macae, RJ, Brazil.[Mendes, C.] Hosp Univ Ufpb Joao Pessoa, Joao Pessoa, Paraiba, Brazil.[Grion, C.] Hosp Univ Londrina, Londrina, Brazil.[Colozza Mecatti, G.] Hosp Univ Sao Francisco, Braganca Paulista, SP, Brazil.[Ferrreira, M.] Santa Casa Caridade Diamantina, Diamantina, MG, Brazil.[Irineu, V] Santa Casa Misericordia Tatui, Tatui, Brazil.[Guerreiro, M.] Sao Francisco de Paula Hosp, Sao Francisco De Paula, RS, Brazil.[Ugarte, S.] Clin Indisa, Providencia, Chile.[Tomicic, V] Clin Las Lilas, Providencia, Chile.[Godoy, C.] Hosp Carlos Van Buren, Valparaiso, Chile.[Samaniego, W.] Hosp Trabajador Santiago, Santiago, Chile.[Escamilla, I] Hosp El Pino, San Bernardo, Chile.[Escamilla, I] Hosp Mutual De Seguridad, Santiago, Chile.[Castro Castro, L.] Ctr Med Imbanaco, Valle Del Cauca, Colombia.[Libreros Duque, G.] Clin Colombia Cali, Cali, Colombia.[Diaz-Guio, D.] Clin Del Cafe, Armenia, Colombia.[Benitez, F.] Clin La Estancia SA, Popayan, Colombia.[Guerra Urrego, A.] Clin Medellin, Medellin, Colombia.[Buitrago, R.] Fdn Clin Shaio, Bogota, Colombia.[Ortiz, G.] Hosp Santa Clara, Bogota, Colomb

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p&lt;0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology