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

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dc.contributor.authorKnight, SR
dc.contributor.authorShaw, CA
dc.contributor.authorPius, R
dc.contributor.authorDrake, TM
dc.contributor.authorNorman, L
dc.contributor.authorAdemuyiwa, AO
dc.contributor.authorAdisa, AO
dc.contributor.authorAguilera, ML
dc.contributor.authorAl-Saqqa, SW
dc.contributor.authoret, al
dc.date.accessioned2022-09-01T08:38:40Z
dc.date.available2022-09-01T08:38:40Z
dc.date.issued2021
dc.descriptionScholarly articleen_US
dc.description.abstractBackground: 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.en_US
dc.identifier.citationGlobalSurg Collaborative and National Institute for Health Research Global Health Research Unit on Global Surgery. Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet. 2021 Jan 30;397(10272):387-397. doi: 10.1016/S0140-6736(21)00001-5. Epub 2021 Jan 21. Erratum in: Lancet. 2021 Mar 6;397(10277):880. PMID: 33485461; PMCID: PMC7846817.en_US
dc.identifier.urihttps://ir.unilag.edu.ng/handle/123456789/11207
dc.language.isoenen_US
dc.publisherElsevier Ltden_US
dc.subjectCanceren_US
dc.subjectHospitalsen_US
dc.subjectGastric cancer surgeryen_US
dc.subjectSurgical procedureen_US
dc.subjectResearch Subject Categories::MEDICINE::Surgeryen_US
dc.titleGlobal variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countriesen_US
dc.typeArticleen_US
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