| Contributors: |
Knight, S. R.; Shaw, C. A.; Pius, R.; Drake, T. M.; Norman, L.; Ademuyiwa, A. O.; Adisa, A. O.; Aguilera, M. L.; Al-Saqqa, S. W.; Al-Slaibi, I.; Bhangu, A.; Biccard, B. M.; Brocklehurst, P.; Costas-Chavarri, A.; Chu, K.; Dare, A.; Elhadi, M.; Fairfield, C. J.; Fitzgerald, J. E.; Ghosh, D.; Glasbey, J.; van Berge Henegouwen, M. I.; Ingabire, J. C. A.; Kingham, T. P.; Lapitan, M. C.; Lawani, I.; Lieske, B.; Lilford, R.; Martin, J.; Mclean, K. A.; Moore, R.; Morton, D.; Nepogodiev, D.; Ntirenganya, F.; Pata, F.; Pinkney, T.; Qureshi, A. U.; Ramos-De la Medina, A.; Riad, A.; Salem, H. K.; Simoes, J.; Spence, R.; Smart, N.; Tabiri, S.; Thomas, H.; Weiser, T. G.; West, M.; Whitaker, J.; Harrison, E. M.; Gjata, A.; Modolo, M. M.; King, S.; Chan, E.; Nahar, S. N.; Waterman, A.; Vervoort, D.; Bedada, A. G.; De Azevedo, B.; Figueiredo, A. G.; Sokolov, M.; Barendegere, V.; Ekwen, G.; Agarwal, A.; Liu, Q.; Camilo Correa, J.; Malemo, K. L.; Bake, J.; Mihanovic, J.; Kuncarova, K.; Orhalmi, J.; Salem, H.; Teras, J.; Kechagias, A.; Arnaud, A. P.; Lindert, J.; Kalles, V.; Aguilera-Arevalo, M. -L.; Recinos, G.; Baranyai, Z.; Kumar, B.; Neelamraju Lakshmi, H.; Zachariah, S. K.; Alexander, P.; Kumar Venkatappa, S.; Pramesh, C.; Amandito, R.; Fleming, C.; Ansaloni, L.; Pellino, G.; Altibi, A. M.; Nour, I.; Hamdun, I.; Ghellai, A. M.; Venskutonis, D.; Poskus, T.; Zilinskas, J.; Malemia, P.; Tew, Y. Y.; Borg, E.; Ellul, S. |
| 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 ... |