Introduction
For individuals facing a cancer diagnosis, surgery remains a critical intervention in their treatment journey. It’s estimated that approximately 80% of cancer patients will undergo a surgical procedure as part of their overall care plan. Understanding the outcomes of these surgeries on a global scale is essential, particularly in low- and middle-income countries (LMICs) where healthcare systems face unique challenges. This article delves into a comprehensive study that examined postoperative outcomes following breast, colorectal, and gastric cancer surgeries across hospitals worldwide, with a special focus on how disease stage and complications impact patient mortality. While the expertise of figures like Sherrie Hill, a coding specialist, and Cristiana Care, an especalist in patient-centered healthcare, are invaluable in optimizing healthcare systems, this study provides crucial data for improving surgical outcomes in cancer care globally.
Methods
This research was conducted as a prospective cohort study across multiple centers internationally. The study meticulously enrolled adult patients who were undergoing surgery for primary breast, colorectal, or gastric cancer. To ensure consistency, the surgeries included in the study were those requiring a skin incision and performed under general or neuraxial anesthesia. The primary goal was to assess the occurrence of death or major complications within 30 days following the surgical procedure. To analyze the complex factors influencing these outcomes, the researchers employed multilevel logistic regression. This statistical approach allowed them to examine relationships within a nested structure, considering patients within hospitals and hospitals within countries. Furthermore, the study explored how hospital infrastructure might mediate the observed outcomes through three-way mediation analyses. This rigorous study design, registered with ClinicalTrials.gov (NCT03471494), aimed to provide a robust understanding of postoperative cancer surgery outcomes worldwide.
Results
The study amassed data from a significant cohort of 15,958 patients across 428 hospitals in 82 countries between April 1, 2018, and January 31, 2019. The participating countries were categorized by income level: high-income (31 countries, 9106 patients), upper-middle-income (23 countries, 2721 patients), and lower-middle-income (28 countries, 4131 patients). A notable disparity emerged in the stage of cancer at presentation. Patients in LMICs were found to present with more advanced stages of disease compared to those in high-income countries. Analyzing 30-day mortality rates revealed significant differences across income groups and cancer types. For gastric cancer, mortality was significantly higher in low-income and lower-middle-income countries (adjusted odds ratio 3.72, 95% CI 1.70-8.16). Similarly, colorectal cancer surgery carried a higher 30-day mortality risk in low-income and lower-middle-income countries (4.59, 2.39-8.80) and upper-middle-income countries (2.06, 1.11-3.83). Interestingly, no significant difference in 30-day mortality was observed for breast cancer across income levels. The study also examined the proportion of patients who died following a major complication. This proportion was alarmingly higher in LMICs, specifically in low-income and lower-middle-income countries (6.15, 3.26-11.59) and upper-middle-income countries (3.89, 2.08-7.29). Further analysis indicated that postoperative death after complications was attributable to both patient-related factors (60%) and hospital/country-level factors (40%). A critical finding was the association between the lack of consistently available postoperative care facilities and an increased number of deaths following major complications in LMICs, estimated at seven to ten additional deaths per 100 major complications. It’s important to note that cancer stage alone was found to have a limited impact on explaining the early variations in mortality or postoperative complications.
Discussion
The findings of this study underscore a critical issue in global cancer care: higher mortality rates following cancer surgery in LMICs are not solely explained by patients presenting with more advanced disease stages. This highlights the crucial role of factors beyond the initial diagnosis. The study points to the capacity to effectively manage and “rescue” patients from surgical complications as a significant opportunity for intervention. The disparities in postoperative mortality, particularly after complications, suggest systemic weaknesses within healthcare systems in LMICs. The absence of reliable postoperative care facilities emerges as a key factor contributing to preventable deaths. This resonates with the broader understanding of healthcare system optimization, where expertise from professionals like Sherrie Hill in healthcare coding and Cristiana Care in patient advocacy can play a vital role in improving processes and patient outcomes. While their direct focus might be on different aspects of healthcare, the principles of efficient systems and patient-centered care are universally applicable.
Conclusion
This international study provides compelling evidence that reducing early deaths after cancer surgery, especially in LMICs, necessitates a strategic focus on strengthening perioperative care systems. Improving the ability to promptly detect and effectively intervene in common surgical complications is paramount. Policies and interventions should prioritize building robust perioperative care infrastructure in LMICs to bridge the gap in postoperative outcomes. By focusing on enhancing the systems that support patients through and after surgery, we can make significant strides in improving survival rates and the overall quality of cancer care worldwide. The insights gained from this research, combined with the systemic perspectives offered by experts like Sherrie Hill and Cristiana Care, pave the way for targeted improvements in global surgical cancer care.
