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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries
The Lancet, Volume 397, No. 10272, Year 2021
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Description
Background: 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. Funding: National Institute for Health Research Global Health Research Unit. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC7846817/bin/mmc1.pdf
Authors & Co-Authors
Shaw, Catherine A.
Unknown Affiliation
Pius, Riinu
Unknown Affiliation
Drake, Thomas M.
Unknown Affiliation
Norman, Lisa
Unknown Affiliation
Ademuyiwa, Adesoji O.
Unknown Affiliation
Adisa, Adewale O.
Unknown Affiliation
Aguilera, Maria Lorena
Unknown Affiliation
Al-Slaibi, Ibrahim
Unknown Affiliation
Bhangu, Aneel Amir
Unknown Affiliation
Biccard, Bruce Mclure
Unknown Affiliation
Brocklehurst, Peter S.
Unknown Affiliation
Costas-Chavarri, Ainhoa
Unknown Affiliation
Chu, Kathryn M.
Unknown Affiliation
Dare, Anna J.
Unknown Affiliation
Elhadi, Muhammed K.
Unknown Affiliation
Fairfield, Cameron J.
Unknown Affiliation
Fitzgerald, James Edward F.
Unknown Affiliation
Ghosh, Dhruv
Unknown Affiliation
Glasbey, James C.
Unknown Affiliation
van Berge Henegouwen, Mark I.
Unknown Affiliation
Ingabire, Jc C.Allen
Unknown Affiliation
Kingham, Thomas Peter
Unknown Affiliation
Lapitan, Marie Carmela M.
Unknown Affiliation
Lawani, Ismaïl
Unknown Affiliation
Lieske, Bettina
Unknown Affiliation
Lilford, Richard J.
Unknown Affiliation
McLean, Kenneth A.
Unknown Affiliation
Moore, Rachel L.
Unknown Affiliation
Dion G. Morton, Dion Gregory M.
Unknown Affiliation
Nepogodiev, Dmitri
Unknown Affiliation
Ntirenganya, Faustin
Unknown Affiliation
Pata, Francesco
Unknown Affiliation
Pinkney, Thomas D.
Unknown Affiliation
Qureshi, Ahmad Uzair
Unknown Affiliation
Ramos-De La Medina, Antonio
Unknown Affiliation
Simoes, Joana F.F.
Unknown Affiliation
Spence, Richard Trafford
Unknown Affiliation
Smart, Neil J.
Unknown Affiliation
Tabiri, Stephen
Unknown Affiliation
Weiser, Thomas G.
Unknown Affiliation
Whitaker, John K.H.
Unknown Affiliation
Harrison, Ewen Munro
Unknown Affiliation
Gjata, Arben
Unknown Affiliation
Modolo, Maria Marta
Unknown Affiliation
King, Sebastian K.
Unknown Affiliation
Nahar, Sayeda Nazmum
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Waterman, Ade
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Vervoort, Dominique V.
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Bedada, Alemayehu G.
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Ekwen, Gerald Takem
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Agarwal, Arnav
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Liu, Qinyang
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Malemo, Kalisya Luc
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Bake, Jacques Fadhili
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Mihanovic, Jakov
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Salem, Hosni K.
Unknown Affiliation
Kechagias, Aristotelis
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Arnaud, Alexis P.
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Lindert, Judith Anne Teresa
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Recinos, Gustavo
Unknown Affiliation
Kumar, Basant S.
Unknown Affiliation
Zachariah, Sanoop Koshy
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Alexander, Philip Vareed
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Pramesh, Conjeevaram S.
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Amandito, Radhian
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Fleming, Christina A.
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Ansaloni, Luca
Unknown Affiliation
Pellino, Gianluca
Unknown Affiliation
Altibi, Ahmed M.A.
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Nour, Ibrahim Rabi
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Ghellai, Ali M.
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Venskutonis, Donatas
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Poškus, Tomas
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Žilinskas, Justas
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Tew, Yong Yong
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Borg, Elaine
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Wafqui, Fatima Zahraa
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Borowski, David W.
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Wells, Cameron I.
Unknown Affiliation
Adamou, Harissou
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Ademuyiwa, Adesoji O.
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Soreide, K.
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Al-Saqqa, Sara W.
Unknown Affiliation
Alser, Osaid H.
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Tahboub, Haya
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Segovia-Lohse, Helmut Alfredo Lfredo
Unknown Affiliation
Shu-Yip, Sebastián B.
Unknown Affiliation
Major, Piotr
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Bratu, Matei Razvan
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Litvin, A. A.
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Vardanyan, A. V.
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Allen-Ingabire, Jean De La Croix
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Gudal, Ahmad
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Albati, Naif Ali
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Rems, Miran
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Rayne, Sarah Louise
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van Straten, Stephanie
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Moodley, Yoshan
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Senanayake, Kithsiri Janakantha
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Omer, Omer Abdelbagi
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Cengiz, Yücel
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Bouaziz, Hanen
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Altinel, Yuksel
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Doe, Matthew J.
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Teasdale, Ella
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Maimbo, Mayaba
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Linyama, David M.
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Fermani, Claudio Gabriel
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Dickfos, Marilla
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Gourlay, Ralph
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Ho, Debbie
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Dawson, Amanda C.
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Pockney, Peter G.
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Wills, Vanessa Lee
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Ye, Geoffrey
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Gyorki, David E.
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Warwick, Andrea Marie
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Dudi-Venkata, Nagendra N.
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Maddern, Guy J.
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Padmore, Greg M.
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Dossou, Francis Moïse
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Gnangnon, Freddy Houehanou Rodrigue
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Imorou Souaïbou, Yacoubou
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Motlaleselelo, Pako
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Tlhomelang, Omphile
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Dardanov, Dragomir
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Maslyankov, Svilen
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Karamanliev, Martin P.
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Atanasov, Boyko Tchavdarov
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Belev, Nikolay
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Slavchev, M.
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Stock, Simon E.
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Kyota, Steve
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Brown, James A.
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Umenze, Franklin
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Boutros, Marylise
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Dumitra, Sinziana
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Garfinkle, Richard
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Liberman, Alexander Sender
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Meterissian, Sarkis H.
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Coburn, Natalie Groce
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Jaffer, Alisha A.
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Karanicolas, Paul Jack
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Sierra, Sebastian
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Pérez Rivera, Carlos José
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Isaza-Restrepo, Andrés
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Domini, Edgar
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Karlo, Robert
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Eltoum, Ruba
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Fadel, Ahmed
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Sayed, Ahmed Kamal
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Gadelkarim, Mohamed
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Sabry, Ahmed
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Elsherif, Fawzia Abdellatif
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Abdelmohsen, Naglaa
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Gamal, Norhan
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Gamal, Mohammed G.
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Hetta, Helal F.
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Omar, Mohammed A.
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Saad, Mahmoud M.
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Shawqi, Muhammad
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Morsy, Mahmoud Hassan
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Refaat, Ahmed
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Sobhy, Mohamed
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Afifi, Eman
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Gadallah, Ahmed
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Munir, Malak
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Shazly, Omar
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Taha, Esraa Yousif
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Wilson, Karim
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Ibrahim, Eman A.
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Metwalli, Maram
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Abdelhakim, Ahmed Mohamed
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Alkhatib, Mo'min
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Gad, A. Mahmoud
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Magdy, Menna Tullah
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Ali, Amr
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Attia, Mohamed Sabry
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Balata, Mohamed
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El Nakeeb, Ayman M.
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Elfallal, Ahmed Hossam
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Elfeki, Hossam Ayman
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Emile, Sameh Hany
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Ezzat, Helmy
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Mansour, Islam Ahmed
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Omar, Waleed H.
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Shalaby, Mostafa
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Badr, Helmy
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Morsi, Mahmoud
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Maher, Ahmed
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Mostafa, Ahmed Morsy
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Samir, M. Ahmed
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Samy, Fatma
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Hussein, Mohamed
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Abdelkhalek, Mohamed
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Atallah, Khalid
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Elsherbeny, Mohammed Yasser
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Hamdy, Mohamed
Unknown Affiliation
Hamdy, Omar
Unknown Affiliation
Metwally, Islam Hany
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Nassar, Ahmad H.M.
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Refky, Basel
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Saleh, Mahmoud M.
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Zuhdy, Mohammad
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Fayed, Notila
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Mohammed, Mohammed Mustafa Hassan
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Sallinen, Ville J.
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Mathonnet, Muriel
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Lavoué, Vincent
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Sulpice, Laurent
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Dousset, Bertrand E.
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Gaujoux, Sébastien
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Agbeko, Anita Eseenam
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Gyabaah, Solomon
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Gyamfi, Frank Enoch
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Yorke, Joseph
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Owusu, Frank
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Abantanga, Francis Atindaana
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Anyomih, Theophilus T.K.
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Sheriff, Mohammed
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Balalis, Dimitrios
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Korkolis, Dimitrios P.
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Gkiokas, Georgios A.
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Ioannidis, Argyrios
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Chouliaras, Christos
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Chatzakis, Christos
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Ioannidis, Orestis M.
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Theodorou, Dimitrios A.
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Garoufalia, Zoe
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Kontos, Michael I.
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Kouraklis, Gregory P.
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Liakakos, Theodore D.
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Baili, Efstratia
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Schizas, Dimitrios N.
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Manatakis, Dimitrios K.
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Badwe, Rajendra Achyut
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Shrikhande, Shailesh Vinayak
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Manangi, Mallikarjuna
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Barati, Nastaran
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Karami, Manoochehr Anocher
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Naderifar, Homa
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Shiwani, Haaris A.
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Nita, Gabriela Elisa
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Occhionorelli, Savino
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Scaramuzzo, Rosa
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Giglio, Mariano Cesare
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Spinelli, Antonino
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Bonavina, Luigi
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Rausa, Emanuele
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Belli, Andrea A.B.
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Bianco, Francesco Maria
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Delrio, Paolo
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Falato, Armando
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Gallo, Gaetano
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Sena, Giuseppe
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Garulli, Gianluca
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Foschi, D. A.
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Cicuttin, Enrico
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Sibilla, Maria Grazia
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Sagnotta, Andrea
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Tamini, Nicolò
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Galleano, R.
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Malerba, Michele
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Cocorullo, Gianfranco F.
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Fontana, Tommaso
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Licari, Leo
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Sgro, Alessandro
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Lapolla, Pierfrancesco
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Mingoli, Andrea
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Birindelli, Arianna
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Tonini, Valeria
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Podda, Mauro Guido
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Borghi, Felice
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Sasia, Diego
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Cillara, Nicola
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Canonico, Silvestro
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Selvaggi, Francesco Paolo
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Albsoul, Nader M.
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AlBsoul, Ahmad
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Amarin, Justin Z.
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Bsisu, Isam
Unknown Affiliation
Statistics
Citations: 99
Authors: 281
Identifiers
Doi:
10.1016/S0140-6736(21)00001-5
ISSN:
01406736
Research Areas
Cancer
Health System And Policy
Study Design
Randomised Control Trial
Cohort Study
Case-Control Study
Study Approach
Quantitative