Notice: Users may be experiencing issues with displaying some pages on stanfordhealthcare.org. We are working closely with our technical teams to resolve the issue as quickly as possible. Thank you for your patience.
 

Learn about the flu shot, COVID-19 vaccine, and our masking policy »

Stanford Health Care

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study LANCET GLOBAL HEALTH Knight, S. R., Chu, K., Lapitan, M., Dare, A. J., Pius, R., Shaw, C. A., Drake, T. M., Norman, L., Ademuyiwa, A. O., Adisa, A. O., Aguilera, M., Al-Saqqa, S. W., Al-Slaibi, I., Bhangu, A., Biccard, B. M., Brocklehurst, P., Costas-Chavarri, A., Elhadi, M., Fairfield, C. J., Fitzgerald, J., Ghosh, D., Glasbey, J., Henegouwen, M., Ingabire, J., Kingham, T., 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., Ramos-De la Medina, A., Riad, A., Salem, H., Simoes, J., Spence, R., Smart, N., Tabiri, S., Thomas, H., West, M., Whitaker, J., Weiser, T. G., Harrison, E. M., GlobalSurg Collaborative, NIHR Global Hlth Res Unit Global S 2022; 10 (7): E1003-E1011

Abstract

Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58-5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23-0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised.National Institute for Health and Care Research.

View details for DOI 10.1016/S2214-109X(22)00168-1

View details for Web of Science ID 000835720300001

View details for PubMedID 35623378

View details for PubMedCentralID PMC9210173