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  • 1
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    Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection
    Oxford University Press (OUP) ; 2019
    In:  BJS Open Vol. 3, No. 3 ( 2019-06), p. 403-414
    Details
    In: BJS Open, Oxford University Press (OUP), Vol. 3, No. 3 ( 2019-06), p. 403-414
    Materialart: Online-Ressource
    ISSN: 2474-9842 , 2474-9842
    URL: Issue
    URL: Article
    DOI: 10.1002/bjs5.2019.3.issue-3
    DOI: 10.1002/bjs5.50138
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2019
    ZDB Id: 2902033-5
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  • 2
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    SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study
    Wiley ; 2022
    In:  Anaesthesia Vol. 77, No. 1 ( 2022-01), p. 28-39
    Details
    In: Anaesthesia, Wiley, Vol. 77, No. 1 ( 2022-01), p. 28-39
    Kurzfassung: SARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS‐CoV‐2; 2.2% (50/2317) in patients with peri‐operative SARS‐CoV‐2; 1.6% (15/953) in patients with recent SARS‐CoV‐2; and 1.0% (11/1148) in patients with previous SARS‐CoV‐2. After adjustment for confounding factors, patients with peri‐operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS‐CoV‐2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS‐CoV‐2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30‐day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS‐CoV‐2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri‐operative or recent SARS‐CoV‐2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS‐CoV‐2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
    Materialart: Online-Ressource
    ISSN: 0003-2409 , 1365-2044
    URL: Issue
    URL: Article
    DOI: 10.1111/anae.v77.1
    DOI: 10.1111/anae.15563
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2022
    ZDB Id: 2003379-5
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  • 3
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    Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study
    Wiley ; 2021
    In:  Anaesthesia Vol. 76, No. 6 ( 2021-06), p. 748-758
    Details
    In: Anaesthesia, Wiley, Vol. 76, No. 6 ( 2021-06), p. 748-758
    Kurzfassung: 주술기 SARS‐CoV‐2 감염은 수술 후 사망률을 증가시킨 다. 본 연구의 목적은 SARS‐CoV‐2에 감염된 환자에서 수술 전 계획된 지연(planned delay)의 최적 기간을 결정하는 것이 었다. 이 국제적 다기관 전향적 코호트 연구에는 2020년 10월 중에 정규 또는 응급 수술을 받은 환자가 포함되었다. 수술 전 SARS‐CoV‐2에 감염된 수술 대상 환자를 이전에 SARS‐ CoV‐2에 감염되지 않은 환자와 비교하였다. 일차 평가변수는 수술 후 30일 이내의 사망률이었다. 로지스틱 회귀분석 모델 을 사용하여 SARS‐CoV‐2 감염에서 수술까지의 경과 시간 에 따라 층화된 보정 30일 이내 사망률(adjusted 30‐day mortality rates)을 계산하였다. 14만 231명의 환자(116개국) 중 3127명(2.2%)이 수술 전에 SARS‐CoV‐2 감염 진단을 받았다. SARS‐CoV‐2에 감염되지 않은 환자의 보정 30일 이내 사망 률은 1.5%였다(95% 신뢰구간[CI] 1.4‐1.5). 수술 전 SARS‐CoV‐2 감염 진단을 받은 환자의 경우, 진단 후 0‐2주, 3‐4주 및 5‐6주 이내에 수술을 받은 환자에서 사망률이 증가하였다 (교차비[odds ratio] [95% CI]는 각각 4.1 [3.3‐4.8] , 3.9 [2.6‐5.1] 및 3.6 [2.0‐5.2] ). SARS‐CoV‐2 진단 후 7주 이상이 지난 뒤 실시된 수술은 기저치와 유사한 사망 위험도를 나타내었다 (교차비[95% CI] 1.5 [0.9‐2.1] ). SARS‐CoV‐2에 감염된 뒤 7주 이상 수술이 연기된 경우, 증상이 지속된 환자는 증상이 관해되었거나 무증상인 환자보다 사망률이 더 높았다(각각 6.0% [95%CI 3.2‐8.7] 대비 2.4% [95%CI 1.4‐3.4] 대비 1.3% [95%CI 0.6‐2.0]). 가능하다면 SARS‐CoV‐2에 감염된 이후 최소 7주 동안 수술을 연기해야 한다. 진단 후 7주 이상 증상 이 지속되는 환자는 추가적인 수술 연기가 도움이 될 수 있다.
    Materialart: Online-Ressource
    ISSN: 0003-2409 , 1365-2044
    URL: Issue
    URL: Article
    DOI: 10.1111/anae.v76.6
    DOI: 10.1111/anae.15458
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2021
    ZDB Id: 2003379-5
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  • 4
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    SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
    Oxford University Press (OUP) ; 2021
    In:  British Journal of Surgery Vol. 108, No. 9 ( 2021-09-27), p. 1056-1063
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 108, No. 9 ( 2021-09-27), p. 1056-1063
    Kurzfassung: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
    Materialart: Online-Ressource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znab101
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2021
    ZDB Id: 2006309-X
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  • 5
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    Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study
    Wiley ; 2021
    In:  Anaesthesia Vol. 76, No. 11 ( 2021-11), p. 1454-1464
    Details
    In: Anaesthesia, Wiley, Vol. 76, No. 11 ( 2021-11), p. 1454-1464
    Kurzfassung: We aimed to determine the impact of pre‐operative isolation on postoperative pulmonary complications after elective surgery during the global SARS‐CoV‐2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre‐defined sub‐group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS‐CoV‐2 infection. Patients who isolated pre‐operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS‐CoV‐2 incidence and high‐income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre‐operative testing; use of COVID‐19‐free pathways; or community SARS‐CoV‐2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.
    Materialart: Online-Ressource
    ISSN: 0003-2409 , 1365-2044
    URL: Issue
    URL: Article
    DOI: 10.1111/anae.v76.11
    DOI: 10.1111/anae.15560
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2021
    ZDB Id: 2003379-5
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  • 6
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    Management and Outcomes Following Surgery for Gastrointestinal Typhoid: An International, Prospective, Multicentre Cohort Study
    Springer Science and Business Media LLC ; 2018
    In:  World Journal of Surgery Vol. 42, No. 10 ( 2018-10), p. 3179-3188
    Details
    In: World Journal of Surgery, Springer Science and Business Media LLC, Vol. 42, No. 10 ( 2018-10), p. 3179-3188
    Materialart: Online-Ressource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s00268-018-4624-8
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2018
    ZDB Id: 1463296-2
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  • 7
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    Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study
    Springer Science and Business Media LLC ; 2018
    In:  Surgical Endoscopy Vol. 32, No. 8 ( 2018-08), p. 3450-3466
    Details
    In: Surgical Endoscopy, Springer Science and Business Media LLC, Vol. 32, No. 8 ( 2018-08), p. 3450-3466
    Kurzfassung: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. Methods This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. Results 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33–4.99, p  = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76–2.52, p  = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42–0.71, p   〈  0.001) and SSIs (OR 0.22, 95% CI 0.14–0.33, p   〈  0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11–0.44) and SSI (OR 0.21 95% CI 0.09–0.45). Conclusion A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. Trial registration: NCT02179112.
    Materialart: Online-Ressource
    ISSN: 0930-2794 , 1432-2218
    URL: Article
    DOI: 10.1007/s00464-018-6064-9
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2018
    ZDB Id: 1463171-4
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  • 8
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    Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy
    Oxford University Press (OUP) ; 2019
    In:  British Journal of Surgery Vol. 106, No. 2 ( 2019-01-08), p. e103-e112
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 106, No. 2 ( 2019-01-08), p. e103-e112
    Kurzfassung: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P & lt; 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P & lt; 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9·4 (95 per cent c.i. −11·9 to −6·9) per cent; P & lt; 0·001), but the relationship was reversed in low-HDI countries (+12·1 (+7·0 to +17·3) per cent; P & lt; 0·001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0·60, 0·50 to 0·73; P & lt; 0·001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.
    Materialart: Online-Ressource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1002/bjs.11051
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2019
    ZDB Id: 2006309-X
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  • 9
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    O19 The effect of malnutrition on early outcomes after elective cancer surgery: an international prospective cohort study in 82 countries
    Oxford University Press (OUP) ; 2021
    In:  British Journal of Surgery Vol. 108, No. Supplement_5 ( 2021-07-30)
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 108, No. Supplement_5 ( 2021-07-30)
    Kurzfassung: Malnutrition is a key priority on the global health agenda, yet the impact of nutritional state on cancer surgery across income strata remains poorly described. This study aimed to determine the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer. Method Multicentre, international prospective cohort study of consecutive patients undergoing elective surgery for colorectal or gastric cancer. Malnutrition was defined using the Global Leadership Initiative on Malnutrition (GLIM) criteria. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression and three-way mediation analysis determined the relationship between country income group, nutritional status and early postoperative outcomes. Result This study included 5709 patients (4593 colorectal; 1116 gastric) from 381 hospitals in 75 countries. Severe malnutrition was present in one third of patients, with a disproportionate burden in upper middle (44%) and low/lower-middle income countries (64%). After adjustment for patient and hospital risk factors, severe malnutrition (aOR 1.62, 95% confidence interval 1.07 to 2.48; P = 0.024) was an independent predictor of 30-day mortality. However, major postoperative complications and surgical site infection rates were similar. Conclusion Severe malnutrition represents a high global burden in cancer surgery, particularly within low-income settings. Malnutrition is an independent risk-factor for 30-day mortality following elective surgery for colorectal or gastric cancer, suggesting perioperative nutritional interventions may improve early outcomes following cancer surgery. Take-home Message Severe malnutrition affects a large proportion of elective surgical oncology patients, with a significantly higher burden in low and middle income countries. Severe malnutrition is independently associated with increased 30-day mortality after cancer surgery.
    Materialart: Online-Ressource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znab282.024
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2021
    ZDB Id: 2006309-X
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  • 10
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    590 Influence of Hospital Characteristics on Patient Outcomes Following Cancer Surgery: An International, Mixed Methods Study Across 66 Countries
    Oxford University Press (OUP) ; 2021
    In:  British Journal of Surgery Vol. 108, No. Supplement_6 ( 2021-10-11)
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 108, No. Supplement_6 ( 2021-10-11)
    Kurzfassung: Early death after cancer surgery is higher in low- and middle-income settings, yet the impact of hospital characteristics on early postoperative outcomes following cancer surgery worldwide are unknown. Method A mixed-methods analysis was performed using data from the GlobalSurg 3 study, a multicentre, international prospective cohort study of patients who underwent surgery for breast, gastric or colorectal cancer. The primary outcomes were 30-day mortality and major complication rates. Hierarchical clustering identified distinct hospital characteristics to create a facility capacity framework. Adjusted outcomes were determined after accounting for patient characteristics and country-income group. Results Hospital-level data were available for 9685 patients across 238 hospitals. The facility capacity framework consisted of seven distinct hospital resources and processes: presence of CT scan, postoperative recovery area, critical care facilities, opioid analgesia availability, oncologist, pathology and radiotherapy services. While complication rates were similar across hospitals with varying facility capacities, hospitals with five or less capacities (116 hospitals, 2251 patients) had increased mortality (aOR 1.67, 95% CI 1.13-2.48; P = 0.010). After adjustment for case-mix and country income group, patients undergoing surgery for gastric and colorectal cancer in hospitals with reduced capacities had higher mortality (6.2 vs. 4.0%; P  & lt; 0.001), predominantly explained by limited capacity to rescue following the development of major complications (61.3 vs. 72.1%; P  & lt; 0.001). Conclusions Hospitals with certain system capacities achieve better outcomes following cancer surgery, independent of country-income group. For cancers amenable to surgical treatment, national cancer care plans should include both surgical capacity building and concurrent hospital facility development to maximise reductions in cancer-associated mortality.
    Materialart: Online-Ressource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znab258.069
    Sprache: Englisch
    Verlag: Oxford University Press (OUP)
    Publikationsdatum: 2021
    ZDB Id: 2006309-X
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