Background 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.Methods 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.Findings 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.Interpretation 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. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study
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Giglio, Mariano Cesare; Greco, Paola Antonella; Luglio, Gaetano; Manfreda, Andrea; Marra, Ester; Mastella, Federica; Pagano, Gianluca; Peltrini, Roberto; Pepe, Vincenzo; Sacco, Michele ;Sollazzo, Viviana; Spiezio, Giovanni; Cianchetti, Ettore; Menduni, Nunzia; Carvello, Michele Maria; Di Candido, Francesca; Spinelli, Antonino; Corsi, Fabio; Sorrentino, Luca; Marino, Fabio; Asti, Emanuele Luigi Giuseppe; Bonavina, Luigi; Rausa, Emanuele; Asta, Martina; Belli, Andrea; Bianco, Francesco ;Cervone, Carmela; Delrio, Paolo; Falato, Armando; Fares Bucci, Andrea; Guarino, Rita; Pace, Ugo; Rega, Daniela; De Luca, Emilia; Gallo, Gaetano; Sammarco, Giuseppe; Sena, Giuseppe; Vescio, Giuseppina; Santandrea, Letizia; Ugolini, Giampaolo; Zattoni, Davide; Chetta, Nicola; Logrieco, Gaetano; Vanella, Serafino; Garulli, Gianluca; Zanini, Nicola; Bondurri, Andrea; Cammarata, Francesco; Colombo, Francesco; Foschi, Diego; Lamperti, Giulia Maria Beatrice; Maffioli, Anna; Sampietro, Gianluca Matteo; Yakushkina, Al'ona; Zaffaroni, Gloria; Ansaloni, Luca; Cicuttin, Enrico; Sibilla, Maria Grazia; Impellizzeri, Harmony ;Inama, Marco ;Moretto, Gianluigi ;Mochet, Sylvie; Ponte, Elisa; Usai, Antonella; Mancini, Stefano; Sagnotta, Andrea; Solinas, Luigi; Bolzonaro, Elisa; Tamini, Nicolò; Curletti, Gianluca; Galleano, Raffaele; Malerba, Michele; Campanella, Sofia; Cocorullo, Gianfranco; Colli, Francesco; De Marco, Paolino; Falco, Nicolò; Fontana, Tommaso; Kamdem Mambou, Leonel jospin; La Brocca, Antonella; Licari, Leo; Randisi, Brenda; Rizzo, Giovanna; Rotolo, Giulia; Salamone, Giuseppe; Tutino, Roberta; Venturelli, Paolina; Malabarba, Stefano; Sgrò, Alessandro; Vella, Ivan; Cirillo, Bruno; Crocetti, Daniele; De Toma, Giorgio; Lapolla, Pierfrancesco; Mingoli, Andrea; Sapienza, Paolo; Belvedere, Angela; Bianchini, Stefania; Binetti, Margherita; Birindelli, Arianna; Tonini, Valeria; Podda, Mauro ;Pulighe, Fabio; De Rosa, Michele; Bono, Lorenzo; Borghi, Felice; Geretto, Paolo; Giuffrida, Maria Carmela; Lauro, Corrado; Marano, Alessandra; Pellegrino, Luca; Salusso, Paola; Sasia, Diego; Campanelli, Michela; Realis Luc, Alberto; Trompetto, Mario; Cardia, Roberto; Cillara, Nicola; Giordano, Antonio Nicola; Costanzo, Antonio; Giovilli, Mario Alessandro; Turati, Luca; Canonico, Silvestro; Pellino, Gianluca; Sciaudone, Guido; Selvaggi, Francesco; Selvaggi, Lucio; Albsoul, Nader; AlBsoul, Ahmad; Alkhatib, Ala'a Aldeen; Alsallaq, Osama; Amarin, Justin Z.; Ayoub, Rami; Bsisu, Isam; El Muhtaseb, M S; Jabaiti, Mohammad; Melhem, Jamal; Nour, Ibrahim; Qwaider, Yasmeen Z.; Salameh, Mohammad Hasan; Suleihat, Ahmad; Suradi, Haya H.; Alammarin, Mohammad; Aljaafreh, Almoutuz; Bani hani, Mohammad; Bani hani, Zeina; Bani Hani, Farah; Fahmawee, Toqa; Hamouri, Shadi; Katanani, Cyrine; Tawalbeh, Ra'fat; Tawalbeh, Tamara; Zawahrah, Hassan; Abou Chaar, Mohamad K.; Abusalem, Lana; Al-Masri, Mahmoud; Al-Najjar, Hani; Barghuthi, Lutfi; Ahmed, Zahra; Maulana, Adnan; Ngotho, Omar; Kamau, Charbel; Stanley Mwenda, Aruyaru; Bosire, Fridah; Mwachiro, Elizabeth; Parker, Robert; Simel, Ian; Sylvester, Kimutai; Althini, Abdulmunem Ahmed Mustafa; Elbarouni, Sofian; Elbeshina, Aya Elseed; Gwea, Ahmed; Malek, Ans; Masoud Farag, Wedad Albashir; Abdalei, Abdulwahab; Abdel Malik, Abu Baker; Abo-khammash, Areej; Abuhlaiga, Ma'aly; Adnan, Nour; Albaggar, Marwa; Alfitory, Asma; Aljanfi, Asma; Almuzghi, Fakhruddin; Altumei, Zohoor; Alzabti, Fatima; Ashoushan, Hana; Assalhi, Mohamed; Azzubia, Joma; Bnhameida, Sondos; Delhen, Malik; Elshafei, Houssein; Elteir, Hana; Esbaga, Fatima; Gobbi, Abdel Aziz; Hamouda, Fatma; Hilan, Hamdan; Ismail, Rania; Jebran, Fieruz; Kasbour, Muataz; Maderi, Galia; Mohammad, Saja; Mohammed, Burooj; Murtadi, Habib; Mustafa, Hamassat; Rajab, Mohamed; Trenba, Sarah; Wafaa, Mariam; Al Sagheir, Eman; Almigheerbi, Alabas; Alzahaf, Ahmed; Bahroun, Sumayyah Ghayth; Ben Dallah, Najah; Elshaibani, Mahmoud; Eswaye, Haitem; Karar, Maha; Omar, Samah; Younes, Eman; Younes, Maha; Zreeg, Dafer; Abujamra, Saleh; Ashour, Firas; Elgammudi, Mala; Omar F. Aljadidi, Wesal; Saddouh, Enas; Sharif, Randa; Alabuzidi, Aya; Alwerfally, AbdulMawlay; Aribi, Sarra; Bibas, Fatma; Elfaituri, Taha; Elhajjaji, Yasmine; Khaled, Ala; Khalil, Wegdan; Layas, Tesneem; Soula, Enas; Tarek, Ahmed; Abu hallalah, Muad fathi khalleefah; Abujamra, Saleh; Ahmed, Hazem Abdelkarem; Alsharef, Tagwa; Ben Saoud, Abdulsalam Ali; El Gharmoul, Tasnim; Elhadi, Ahmed; Elrais, Safa; Shebani, Abdulhalim; Zarti, Heba; Zeiton, Asaid; Ambrazevicius, Marijus; Kaselis, Nerijus; Stakyte, Migle; Aliosin, Oleg; Cizauskaite, Agne; Dailidenas, Sarunas; Eismontas, Vitalijus; Kybransiene, Migle; Nutautiene, Vitalija; Samalavicius, Narimantas; Simcikas, Dainius; Slepavicius, Algirdas; Tamosiunas, Albinas; Ubartas, Nerijus; Zeromskas, Paulius; Bradulskis, Saulius; Dainius, Edvinas; Juočas, Juozas; Kubiliute, Egle; Kutkevičius, Juozas; Opolskis, Aurimas; Parseliunas, Audrius; Subocius, Andrejus; Venskutonis, Donatas; Virbickaite, Egle; Zuikyte, Diana; Bogusevicius, Algirdas; Buzaite, Kristina; Čepuliené, Daiva; Cesleviciene, Ieva; Cesna, Vaidotas; Gribauskaite, Jolanta; Ignatavicius, Povilas; Jokubauskas, Mantas; Liugailaitè, Monika; Margelis, Ernest; Mazelyte, Ruta; Pankratjevaitè, Lina; Pažusis, Matas; Rackeviciute, Agne; Saladyte, Justina; Škimelytè, Monika; Šlenfuktas, Vygintas; Sudeikyte, Monika; Tamelis, Algimantas; Vanagas, Tomas; Žumbakys, Žygimantas; Atkociunas, Aivaras; Dulskas, Audrius; Kuliavas, Justas; Birutis, Justas; Paškevičius, Sigitas; Šatkauskas, Mindaugas; Danys, Donatas; Jakubauskas, Matas; Jakubauskiene, Lina; Kryzauskas, Marius; Lipnickas, Vytautas; Makūnaitè, Gabija; Rasoaherinomenjanahary, Fanjandrainy; Rasolofonarivo, Herizo; Samison, Luc Hervé; Banda, Bitiel; Malemia, Precious; Msosa, Vanessa; Ahmad Izzuddin, Ahmad Imran; Das, Andre; Gan, Ying Yee; Shong Sheng, Tan; Siaw, Jia yng; Ab Rahim, Mohd Fadliyazid; Abang Jamari, Dyg Zahratul Hamrak; Che Husin, Nurfariza; Kamarulzaman, Muhd Yusairi; Lim, Yi Ping; Mohamed Kamil, Nil Amri; Mohd Hassan, Mohd Razeen; Mohd Sahid, Saidah; Mustafa, Johari; Ng, Elaine Hui Been; Wan Khazim, Wan Khamizar; Chang Ern, Ng; Lingeshan, P. g.; Sulaiman, Syariz Ezuan; Ang, Sue Ean; Bin Mohamad Sithik, Muhammad Navid; Cheong, Yih Jeng; Deva Tata, Mahadevan; Jia Xian, Law; Kadravello, Aravinthan; Koh, I-Ern; Ng, Li-Yen; Ng We Yong, Yuki Julius; Palayan, Kandasami; Sam, Chi Xuan; Siow Jin, Phuah; Tan Ern Hwei, Jeremy; Tang, Yita; Ter, Alvin Zubin; Wong, Michael Pak-Kai; Zakaria, Andee Dzulkarnaen; Zakaria, Zaidi; Henry, Fitjerald; Kalaiselvan, Thyivya; Abd Karim, Muhammad Fairuz Shah; Abdul Aziz, Mohamed Rezal; Abdul Aziz, Nora; Khong, Tak Loon; Lau, Peng Choong; Lim, Hiong Chin; Roslani, April Camilla; Seak, Jonathan Chen Ken; Wong, Sui-Weng; Wong, Lai Fen; Yeen Chin, Leow; Anyanwu, Mercy Chinemerem; Borg, Elaine; Busuttil, Zachary; Calleja, Thomas; Chircop, Kurt Lee; Cutajar, Ruth; Dimech, Andrew Michael; Ellul, Sarah; Galea, Joseph; Gascon Perai, Kiara; Gatt, Ruth; Kelman, Lisa; Micallef, Elizabeth; Nwolu, Favour; Sammut, Kim; Thompson, Joanna; Warwicker, Sean; Zammit, Matthew; Cordera, Fernando; Cruz González, Efraín; Sánchez-García, Jorge; Barbosa Camacho, Francisco José; Barrera López, Francisco Javier; Zuloaga Fernandez del Valle, Carlos Jose; Acosta, Eric; González Espinoza, Iván Romarico; Moreno, Perla; Cortes-Flores, Ana Olivia; Fuentes Orozco, Clotilde; Gonzalez Ojeda, Alejandro; Corro Díaz González, Samantha; Martinez, Laura; Ramos-De la Medina, Antonio; Mosqueda Amador, Bonifacio; Novoa, Armando; Olazo Espejo, Dennet Arturo; Jimenez, Alejandro; Lopez Rosales, Federico; Vanoye, Elva Gabriela; Garcia Gonzalez, Luis Alberto; Miranda-Ackerman, Roberto Carlos; Solano-Genesta, Manuel; Alvarez-Cano, Alethia; Romero-Garza, Hector Hugo; Medina-Franco, Heriberto; Mejía-Fernández, Lorelí; Salgado-Nesme, Noel; Vergara-Fernandez, Omar; Gutiérrez-Mota, Guadalupe Montserrat; Hernandez Vera, Francisco Xavier; Llantada Lopez, Anabella; Morgan Villela, Gilberto; Ramirez Padilla, Felipe de Jesus; Tapia Marin, Walezka; Martínez Maldonado, Mónica; Sánchez Suárez, Ramses; Troche, José Manuel; Benyaiche, Chaymae; Outani, Oumaima; Amine, Souadka; Benkabbou, Amine; Majbar, Anass Mohammed; Mohsine, Raouf; Rafik, Ali; Oung, Thida; Tin, Moe Moe; Borowski, David W; Plarre, Philipp; Borowski, David W; Plarre, Philipp; Alberga, Anna; Sluiter, Nina; Tuynman, Jurriaan; Blok, Robin; Cömert, Didem; Hompes, Roel; Kalff, Marianne; Stellingwerf, Merel Elisabeth; Tanis, Pieter; van Berge Henegouwen, Mark; van Praag, Elise Maria; Wisselink, Daan; Gerhards, Michael; Lopes Cardozo, Josephine; Westerduin, Emma; de Jonge, Joske; van Geloven, Aaw; van Schilt, Kaz; den Boer, Frank; Stoots, Simone; Vlek, Stijn; Adams, Jamie; Al-Busaidi, Ibrahim S.; Budd, Gabrielle; Choi, Seung il; Chu, Michael Jen Jie; Ganugapati, Anurag; McKinstry, Lucy; Pascoe, Rebecca; Richards, Simon; Rosser, Kenrick; Stevenson, Annie; White, Rebecca; Farik, Shebani; Kwun, Jin; Murad, Ahmed; Cowan, Sarah; Hall, Timothy; Hayton, Michael; Malam Sani, Laminou; Oumarou Garba, Souleymane; Adamou, Harissou; Amadou Magagi, Ibrahim; Habou, Oumarou; Aliyu, Halima; Daniyan, Muhammad; Sholadoye, Tunde T.; Abdullahi, Lawal; Anyanwu, Lofty-John; Mohammad Mohammad, Aminu; Muhammad, Abubakar Bala; Sheshe, Abdurrahman Abba; Suleiman, Ibrahim; Adesina, Alaba; Awolowo, Ajibola; Onuoha, Clement; Salami, Omotayo; Taiwo, Ogechukwu; Taiwo, Agboola; Kache, Stephen; Makama, Jerry Godfrey; Sale, Danjuma; Abiola, Olajide; Ajao, Akinlabi; Ajiboye, Anthony; Etonyeaku, Amarachukwu; Olaogun, Julius; Adebanjo, Ademola; Adesanya, Opeoluwa; Afolayan, Michael Olatunji; Balogun, Olanrewaju; Makanjuola, Ayomide; Nwokocha, Samuel; Ojewola, Rufus Wale; Olajide, Thomas Olagboyega; Aderounmu, Adewale; Adesunkanmi, Abdul-Rashid; Adisa, Adewale; Agbakwuru, Augustine; Akeem Aderogba, Adeleke; Alatise, Olusegun Isaac; Arowolo, Olukayode; Lawal, Oladejo; Mohammed, Tajudeen; Ndegbu, Chinedu; Olasehinde, Olalekan; Wuraola, Funmilola; Akinkuolie, Akinbolaji; Etonyeaku, Amarachukwu; Mosanya, Arinzechukwu; Ayandipo, Omobolaji; Elemile, Peter; Lawal, Taiwo Akeem; Ali SANI, Samuel; Garba, Stephen; Hauwa SANI, Rebecca; Olori, Samson; Onyebuashi, Henry; Umoke, Ifeanyi; Adenuga, Adedire; Adeyeye, Ademola; Habeeb, Olufemi; Lawal, Bashir; Nasir, Abdulrasheed; Aahlin, Eirik Kjus; Kjønås, Didrik; Myrseth, Elisabeth; Abbasy, Jibran; Alvi, Abdul; Saleem, Omair; Afzal, Asma; Nazir, Anam; Farooq, Muhammad; Liaqat, Ayesha; Naqi, Syed Asghar; Raza, Ali; Sarfraz, Muzna; Sarwar, Muhammad; Banglani, Muntaha; Munir, Ambreen; Sehrish, Rahmat; Ayub, Bushra; Sayyed, Raza; Altaf, Amna; Ayub, Saima; Qureshi, Ahmad Uzair; Saeed, Komal; Syed, Bilal; Akbar, Sana Amir; Anwer, Abdul Wahid; Khan, Ruqayya Naheed; Khan, Amina Iqbal; Khattak, Shahid; Mohtasham, Sameen; Parvaiz, Muhammad Asad; Syed, Aamir Ali; Ansari, Abdul Basit; Shahzad, Noman; Khaliq, Tanwir; Rashid, Isbah; Waqar, Shahzad Hussain; Abu Al-saleem, Hasan; Abu Alqumboz, Amjad; Alqadi, Mohammad; Amro, Adham; Assa, Rawan; Awesat, Eman; Ayyad, Rawan; Hammad, Mohammed; Haymony, Ayat; Hijazi, Bassel; Hmeidat, Bara; Lahaseh, Rowaa; Qawasmi, Aseel; Rajabi, Alaa; Shehada, Mohammed; Shkokani, Sundus; Yaghi, Yasmine; Yaghi, Nadine; AlZohour, Mohammad; Farid, Mohammad; Habes, Yousef Mahmoud; Juba, Wesam; Nubani, Yanal; Rabee, Abdelrahman; Sa'deh, Mohammad; Abed, Saeed; Al basos, Iyad; Alswerki, Mohammad; Ashour, Dina; Awad, Israa; Diab, Samar; El Jamassi, Alaa; El-Kahlout, Sahar; Elhout, Somaya; Hajjaj, Ahmed N K; Hasanain, Doaa; Nabil hajjaj, Baraa; Obaid, Mohammed; Saikaly, Eman; Salhi, Ahmed; Al-Tammam, Hiba; Almasri, Murad; Baniowda, Muath; Beshtawi, Doha; Horoub, Ali; Misk, Rami; Mohammad, Bayan; Qasrawi, Rami; Sholi, Tasnim; Abu-Nimeh, Samar; Abu-srour, Abrar; Abukhalaf, Sadi A.; Adawi, Samer; Alsalameh, Barah; Ayesh, Kholoud; Elqadi, Muawiyah; Hammouri, Ahmad; Karim Mustafa, Fatima; Marzouqa, Natalie; Melhem, Shatha; Miqdad, Dima; Mohamad, Balqees; Rawhi, Mhammed; Abu Ahammala, Ayman B.; Abu Ataya, Ahmed; Abu Jayyab, Israa; Al-Shwaikh, Samar; Alagha, Othman; Alasttal, Mohammed; Awadallah, Haneen; Elblbessy, Mahmood; Fares, Jehad; Jarbou, Akram; Mahfouz, Ibtisam; Albahnasawi, Moath A.; Abo mahadi, Asmaa'; Abuelhatal, Hasan; Abuelqomboz, Ayham; Almoqayyad, Abdelrahman; Alwali, Abdallah; Balaawi, Reem; Hamouda, Mahmoud; Humeid, Mohammed; Jedyan, Abdullah; Mahmoud Abu hamam, Tasneem; Matar, Ghadeer; Salem, Ali; Samra, Tahani; Shaheen, Nureddin; Shihada, Karam; A. Nemer, Ayoob; Abu Al Amrain, Mahmoud; Abu Alamrain, Abdulwhhab; Abu Jamie, Najlaa; Abu-Rous, Mohammed R.; Alfarra, Nada; AlTaweel, Mohammed; Alwhaidi, Noor; Hamed, Ramadan; Saqqa, Bader; Shaheen, Ahmad; Aljaber, Dana; Aljaberi, Loay; Alwaheidi, Malak; Jawaada, Assef; Khaldi, Hani; Qahoush, Rami; Qari, Jalil; Saadeh, Rana; Salim, Ahlam; Yacoub, Aseel; Abbas, Abbas; Abu shua'ib, Rana; Abu Zainah, Baraa; AbuSirrees, Mahmoud; Babaa, Basheer; Barhoush, Ola; Belal qadomi, Asef; Daraghmeh, Laith; Haji, Reema; Khatatbeh, Alaa; Khatib, Lana; Qarariah, Salsabeel; Quzmar, Yara; Safadi, Khalil; Salameh, Roqaya; Hassan, Mohammad; Herzallah, Shifaa; Massad, Loai; Nazzal, Ahmed; Nazzal, Ranin; Escobar, Dennis; Machain V, Gustavo Miguel; Rodriguez Gonzalez, Agustin; Chachaima Mar, Jorge Emerson; Chinchihualpa Paredes, Nathaly Olga; Cuba, Vicente; Lopez, Walter; Niquen Jimenez, Maria Milagros; Sanchez Bartra, Nestor Alberto; Sapallanay Ojeda, Olenka; Sequeiros, Diego; Toscano Pacheco, Andrea; Vergara, María; Abarca, Sol; Alcorta, Rodrigo; Borda-Luque, Giuliano; Eusebio Zegarra, Ivan Edward; Luján López, Claudia; Marrufo, Mirella; Mogrovejo, Cinthya; Nomura, Andrea; Rodríguez Angeles, Yamile; Vidal Meza, Maitza Rosario; Zavala, Gabriela; Castillo Arrascue, José Neiser; Hidrogo Cabrera, Jomara Caroline; Larrea vera, José Julio Mariano; Osorio, Miguel; Ylatoma Díaz, Edgar Alcides; Fontanilla, Mark Anthony; Fuentes, Joseph Roy; Salazar, Anna Leah; Dominguez, Genieve; Lopez, Marc Paul; Macalindong, Shiela; Onglao, Mark Augustine; Ramirez, Arjel; Sacdalan, Marie Dione; Tampo, Mayou Martin; Uy, Gemma Leonora; Mangahas, Jeremiah; Yabut, Kenneth; Cañete, Joannes Paul; Cansana, Bernalynn Eris; Castro, Ernes John; Lipana, Maria Kaiserin; Roxas, Manuel Francisco; Zara, Vlu Jean; Chroł, Maciej; Franczak, Paula; Orłowski, Michał; Budzyński, Piotr; Budzyński, Andrzej; Bury, Pawel; Czerwińska, Agata; Dworak, Jadwiga; Dziedzic, Jacek; Kisielewski, Michał; Kulawik, Jan; Lasek, Anna; Major, Piotr; Małczak, Piotr; Migaczewski, Marcin;