ICU Risk Stratification Models Feasible for Use in Sub-Saharan Africa Show Poor Discrimination in Malawi: A Prospective Cohort Study.

Abstract:

BACKGROUND:Critical illness disproportionately affects people in low-income countries (LICs). Efforts to improve critical care in LICs must account for differences in demographics and infrastructure compared to high-income settings. Part of this effort includes the development and validation of intensive care unit (ICU) risk stratification models feasible for use in LICs. The purpose of this study was to validate and compare the performance of ICU mortality models developed for use in sub-Saharan Africa. MATERIALS AND METHODS:This was a prospective, observational cohort study of ICU patients in a referral hospital in Malawi. Models were selected for comparison based on a Medline search for studies which developed ICU mortality models based on cohorts in sub-Saharan Africa. Model discrimination was evaluated using the area under the curve with 95% confidence intervals (CI). RESULTS:During the study, 499 patients were admitted to the study ICU, and after exclusions, there were 319 patients. The cohort was 62% female, with the mean age 31 years (IQR: 23-41), and 74% had surgery preceding ICU admission. Discrimination for hospital mortality ranged from 0.54 (95% CI 0.48, 0.60) for the Universal Vital Assessment (UVA) to 0.72 (95% CI 0.66, 0.78) for the Malawi Intensive care Mortality Evaluation (MIME). After tenfold cross-validation, these results were unchanged. CONCLUSIONS:The MIME outperformed other models in this prospective study. Most ICU models developed for LICs had poor to modest discrimination for hospital mortality. Future research may contribute to a better risk stratification model for LICs by refining and enhancing the MIME.

journal_name

World J Surg

journal_title

World journal of surgery

authors

Prin M,Pan S,Kadyaudzu C,Li G,Charles A

doi

10.1007/s00268-019-05078-9

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

2357-2364

issue

10

eissn

0364-2313

issn

1432-2323

pii

10.1007/s00268-019-05078-9

journal_volume

43

pub_type

杂志文章
  • Efficacy of cholestyramine ointment in reduction of postoperative pain and pain during defecation after open hemorrhoidectomy: results of a prospective, single-center, randomized, double-blind, placebo-controlled trial.

    abstract:BACKGROUND:The aim of the present study was to evaluate the efficacy of cholestyramine ointment (15 %) in reducing postoperative pain at rest and during defecation after open hemorrhoidectomy. METHODS:A total of 91 patients with third and fourth degree hemorrhoids undergoing open hemorrhoidectomy were included in this...

    journal_title:World journal of surgery

    pub_type: 杂志文章,随机对照试验

    doi:10.1007/s00268-012-1895-3

    authors: Ala S,Eshghi F,Enayatifard R,Fazel P,Rezaei B,Hadianamrei R

    更新日期:2013-03-01 00:00:00

  • Postoperative complications affect long-term survival outcomes following hepatic resection for colorectal liver metastasis.

    abstract:BACKGROUND:The impact of postoperative complications (POCs) on long-term survival outcomes following hepatic resection for colorectal liver metastasis (CRLM) is in controversy. The aim of the present meta-analysis was to systematically evaluate the POC effect on overall survival (OS) and disease-free survival (DFS) in ...

    journal_title:World journal of surgery

    pub_type: 杂志文章,meta分析,评审

    doi:10.1007/s00268-015-3019-3

    authors: Yin Z,Huang X,Ma T,Jin H,Lin Y,Yu M,Jian Z

    更新日期:2015-07-01 00:00:00

  • Radiological evaluation of benign breast disorders.

    abstract::The radiological features of common benign conditions of the breast and the radiological procedures used in the investigation of benign breast disorders are presented. ...

    journal_title:World journal of surgery

    pub_type: 杂志文章,评审

    doi:10.1007/BF01658415

    authors: Gravelle IH,Lyons K

    更新日期:1989-11-01 00:00:00

  • Wound management in disaster settings.

    abstract:BACKGROUND:Few guidelines exist for the initial management of wounds in disaster settings. As wounds sustained are often contaminated, there is a high risk of further complications from infection, both local and systemic. Healthcare workers with little to no surgical training often provide early wound care, and where r...

    journal_title:World journal of surgery

    pub_type: 杂志文章,评审

    doi:10.1007/s00268-014-2663-3

    authors: Wuthisuthimethawee P,Lindquist SJ,Sandler N,Clavisi O,Korin S,Watters D,Gruen RL

    更新日期:2015-04-01 00:00:00

  • Positive Lymph Nodes in Adrenocortical Carcinoma: What Does It Mean?

    abstract:BACKGROUND:The role of lymphadenectomy in adrenocortical carcinoma resection is controversial. Therefore, we conducted a population-based study to assess the association between positive lymph nodes (LN) and survival. METHODS:The Surveillance, Epidemiology, and End Results set of cancer registries were utilized. The a...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-020-05801-x

    authors: Sada A,Glasgow AE,Lyden ML,Thompson GB,Dy BM,McKenzie TJ,Habermann EB

    更新日期:2021-01-01 00:00:00

  • Pathologic aspects of gastrinomas in patients with Zollinger-Ellison syndrome with and without multiple endocrine neoplasia type I.

    abstract::During the three decades since the recognition of the Zollinger-Ellison syndrome (ZES), major progress has been made in the diagnosis and treatment of this disease. However, the many failed operations in patients with ZES, the existence of primary lymph node gastrinomas, and the surgical approach of patients with ZES ...

    journal_title:World journal of surgery

    pub_type: 杂志文章,评审

    doi:10.1007/BF01655107

    authors: Pipeleers-Marichal M,Donow C,Heitz PU,Klöppel G

    更新日期:1993-07-01 00:00:00

  • Management of groin hernias by laparoscopy.

    abstract::The surgical treatment of groin hernias continues to undergo technical modifications. The introduction of minimally invasive surgery had added a possible new dimension, replacing an inguinal approach by laparoscopy. Conceived some 15 years ago, the thesis was subjected to a clinical trial where coincidental abdominal ...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/BF01655704

    authors: Ger R,Mishrick A,Hurwitz J,Romero C,Oddsen R

    更新日期:1993-01-01 00:00:00

  • Patterns of intestinal motility recovery during the early stage following abdominal surgery: clinical and manometric study.

    abstract::The purpose of this study was to evaluate the pattern of recovery of intestinal motility using manometric and clinical assessment in the postoperative ileus following abdominal surgery. We reviewed the charts of 18 patients who underwent partial colectomy for colon cancer (group A, without vagotomy) and compared them ...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s002689900310

    authors: Shibata Y,Toyoda S,Nimura Y,Miyati M

    更新日期:1997-10-01 00:00:00

  • Liver Resection for Hepatocellular Carcinoma in Patients with Renal Dysfunction.

    abstract:BACKGROUND:The aim of this study was to evaluate the feasibility of liver resection in hepatocellular carcinoma (HCC) patients with preoperative renal dysfunction (RD). METHODS:Data from 735 patients undergoing primary liver resection for HCC between 2002 and 2014 were analyzed. Short- and long-term outcomes were comp...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-018-4698-3

    authors: Shirata C,Hasegawa K,Kokudo T,Yamashita S,Yamamoto S,Arita J,Akamatsu N,Kaneko J,Sakamoto Y,Kokudo N

    更新日期:2018-12-01 00:00:00

  • Dropped gallstones during laparoscopic cholecystectomy: the consequences.

    abstract::During laparoscopic cholecystectomy, gallbladder perforation has been reported, leading to bile leak and spillage of gallstones into the peritoneum. Because the consequences can be dangerous, conversion to laparotomy as an instant management for gallstone spillage is one of the topics of current discussion in laparosc...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-004-7588-9

    authors: Tumer AR,Yüksek YN,Yasti AC,Gözalan U,Kama NA

    更新日期:2005-04-01 00:00:00

  • The Scale-Up of the Global Surgical Workforce: Can Estimates be Achieved by 2030?

    abstract:BACKGROUND:The Lancet Commission on Global Surgery showed that countries with surgeon, anesthetist, and obstetrician (SAO) densities of 20-40 SAO/100,000 population were associated with improved health outcomes and recommended a global surgical workforce scale-up by 2030. Whether countries would be able to achieve such...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-019-05329-9

    authors: Daniels KM,Riesel JN,Verguet S,Meara JG,Shrime MG

    更新日期:2020-04-01 00:00:00

  • Analysis of 203 patients with penetrating neck injuries.

    abstract:BACKGROUND:Selective nonoperative management (SNOM) of penetrating neck injuries (PNI) has steadily gained favor, but indications for surgery and adjunctive diagnostic studies remain debated. The purpose of the present study is to validate a protocol of SNOM of PNI based on physical examination, which further dictates ...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-008-9766-7

    authors: Thoma M,Navsaria PH,Edu S,Nicol AJ

    更新日期:2008-12-01 00:00:00

  • Analysis of Surgical Adverse Events at a Major University Hospital in South Africa.

    abstract:BACKGROUND:Surgical 'never events' have serious adverse outcomes for patients. A never event can be defined as a serious, avoidable patient safety incident that would not occur if necessary preventative measures are implemented. The literature from South Africa on this topic is limited. This study aims to understand th...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-019-05008-9

    authors: Wain H,Kong V,Bruce J,Laing G,Clarke D

    更新日期:2019-09-01 00:00:00

  • Irradiated trauma victims: the impact of ionizing radiation on surgical considerations following a nuclear mishap.

    abstract::The combination of conventional traumatic injuries and radiation exposure has synergistic consequences, the full extent of which may take days to weeks to become apparent. Our understanding of such is derived from a variety of laboratory and clinical scenarios involving both therapeutic and accidental exposures. When ...

    journal_title:World journal of surgery

    pub_type: 杂志文章,评审

    doi:10.1007/BF02066992

    authors: Hirsch EF,Bowers GJ

    更新日期:1992-09-01 00:00:00

  • Postmastectomy morbidity after combination preoperative irradiation and chemotherapy for locally advanced breast cancer.

    abstract::Neoadjuvant therapy for locally advanced breast cancer improves disease control, but the complications of treatment are not well established. The aim of this study was to assess the operative morbidity in 20 consecutive patients with locally advanced, noninflammatory breast cancer treated with preoperative chemotherap...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/BF01658934

    authors: Sauter ER,Eisenberg BL,Hoffman JP,Ottery FD,Boraas MC,Goldstein LJ,Solin LJ

    更新日期:1993-03-01 00:00:00

  • A new technique of hepatic segmentectomy by selective portal venous occlusion using a balloon catheter through a branch of the superior mesenteric vein.

    abstract:BACKGROUND:We describe a new technique of segment-based liver resection by inserting a 6 French balloon catheter into the portal vein via a branch of the superior mesenteric vein. MATERIALS AND METHODS:The catheter was guided into the relevant portal branch supplying the liver segment that contained the tumor. Injecti...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-007-9043-1

    authors: Ou JR,Chen W,Lau WY

    更新日期:2007-06-01 00:00:00

  • District General Hospital Surgical Capacity and Mortality Trends in Patients with Acute Abdomen in Malawi.

    abstract:BACKGROUND:The burden of emergency general surgery conditions is high in sub-Saharan Africa, and poor access to surgical care leads to poor patient outcomes. We examined the trends in mortality in patients presenting with an acute abdomen to a referral hospital. METHODS:A retrospective analysis of the prospectively co...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-020-05468-4

    authors: Purcell LN,Robinson B,Msosa V,Gallaher J,Charles A

    更新日期:2020-07-01 00:00:00

  • Hepatic resection combined with portal vein or hepatic artery reconstruction for advanced carcinoma of the hilar bile duct and gallbladder.

    abstract::Hepatectomy with vascular reconstruction for biliary malignancy remains controversial. This study aimed to clarify the indications for surgery. Patients with advanced hilar bile duct cancer (HBDC) (n = 26) and gallbladder cancer (GBC) involving the hepatoduodenal ligament (n = 13) who underwent hepatectomy were enroll...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-003-6801-6

    authors: Shimada H,Endo I,Sugita M,Masunari H,Fujii Y,Tanaka K,Misuta K,Sekido H,Togo S

    更新日期:2003-10-01 00:00:00

  • Simulation for team training and assessment: case studies of online training with virtual worlds.

    abstract::Individuals in clinical training programs concerned with critical medical care must learn to manage clinical cases effectively as a member of a team. However, practice on live patients is often unpredictable and frequently repetitive. The widely substituted alternative for real patients-high-fidelity, manikin-based si...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-007-9354-2

    authors: LeRoy Heinrichs W,Youngblood P,Harter PM,Dev P

    更新日期:2008-02-01 00:00:00

  • Lack of association between microsatellite instability and benign adrenal tumors.

    abstract:BACKGROUND:The adrenal gland may give rise to pheochromocytomas, which are catecholamine-producing tumors originating from the adrenal medulla, or to adrenocortical tumors, which derive from the adrenocortical cortex and may be secreting or not. The genetic mechanisms underlying the formation of these tumors include so...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-005-0471-5

    authors: Namour F,Ayav A,Lu X,Klein M,Muresan M,Bresler L,Tramoy D,Guéant JL,Brunaud L

    更新日期:2006-07-01 00:00:00

  • Helicobacter pylori infection: augmentation of telomerase activity in cancer and noncancerous tissues.

    abstract::Telomerase adds hexameric repeats of 5'-TTAGGG-3' to the ends of chromosomal DNA (telomere) and has been implicated in cell immortalization and cellular senescence. The aim of this study was to measure quantitatively the telomerase activity and human telomerase RNA component (hTR) content in gastric cancer and to exam...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s002680010246

    authors: Kameshima H,Yagihashi A,Yajima T,Kobayashi D,Denno R,Hirata K,Watanabe N

    更新日期:2000-10-01 00:00:00

  • Small artery reconstruction with a new vascular prosthesis.

    abstract::In the Surgical Department of the University of Erlangen, 307 reconstructions in all areas of the arterial tree were performed with PTFE (GORE-TEX) grafts, of which 188 were performed in the femoral-popliteal and femoral-crural areas. Femoral-popliteal bypass grafts above the knee joint remained patent in 93% of the p...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/BF02393582

    authors: Raithel D,Groitl H

    更新日期:1980-01-01 00:00:00

  • The influence of surgery on the risk of death in patients with primary hyperparathyroidism.

    abstract::The previous finding of an increased risk of premature death in a consecutive series of 896 patients operated on for primary hyperparathyroidism between 1953 and 1982 [1] raised the question of the role that surgery plays in relation to the risk of death. In the present study, undertaken to examine that issue, 3 facto...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/BF01658740

    authors: Hedbäck G,Odén A,Tisell LE

    更新日期:1991-05-01 00:00:00

  • Intestinal bowel lengthening in children with short bowel syndrome: systematic review of the Bianchi and STEP procedures.

    abstract:BACKGROUND:It has been thirty years since Bianchi introduced the technique that made intestinal lengthening possible. The last three decades have seen lengthening procedures established as vital components of intestinal rehabilitation programs. The goal of the present study was to use a systematic literature review to ...

    journal_title:World journal of surgery

    pub_type: 杂志文章,评审

    doi:10.1007/s00268-012-1879-3

    authors: King B,Carlson G,Khalil BA,Morabito A

    更新日期:2013-03-01 00:00:00

  • Fibroepithelial Lesions (FELs) of the Breast: Is Routine Excision Always Necessary?

    abstract:BACKGROUND:When needle core biopsies (NCBs) of the breast reveal fibroepithelial lesions (FELs), excision is often performed to rule out a phyllodes tumor (PT), despite low malignancy rates. Consequently, the natural history of observed FELs is not well described. We analyzed the malignancy risk in excised FELs and the...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-020-05385-6

    authors: Limberg J,Barker K,Hoda S,Simmons R,Michaels A,Marti JL

    更新日期:2020-05-01 00:00:00

  • Systemic chemotherapy for malignant melanoma.

    abstract::Malignant melanoma is notoriously resistant to chemotherapy. Standard single agents include dacarbazine and the nitrosoureas, but most series treating patients with metastatic melanoma report response rates of about 20%. Occasional patients, however, achieve long term remission, amounting to cure, after such treatment...

    journal_title:World journal of surgery

    pub_type: 杂志文章,评审

    doi:10.1007/BF02071532

    authors: Coates AS

    更新日期:1992-03-01 00:00:00

  • Diaphragm myoplasty in the prevention of complications after surgery of hydatid disease of the liver.

    abstract::A variety of techniques have been used for surgical treatment of hepatic hydatid cysts. The objective of this study is to describe the technique of diaphragm myoplasty, and to present our experience in the treatment of selected patients with hydatid disease of the liver by means of this alternative surgical technique....

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-002-6558-3

    authors: Dosios T,Kouraklis G,Karatzas G

    更新日期:2003-02-01 00:00:00

  • Long-Term Results After Stapled Hemorrhoidopexy: A 15-Year Follow-Up.

    abstract:BACKGROUND:The stapled hemorrhoidopexy is reported to have a low recurrence while treating the major hemorrhoidal symptoms of bleeding and prolapse. The aim of this study is to obtain long-term results on the outcome of the stapled hemorrhoidopexy. METHODS:All patients with a hemorrhoidal disease grade III, who underw...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-019-05065-0

    authors: Schneider R,Jäger P,Ommer A

    更新日期:2019-10-01 00:00:00

  • The Challenges of Implementing Artificial Intelligence into Surgical Practice.

    abstract:BACKGROUND:Artificial intelligence is touted as the future of medicine. Classical algorithms for the detection of common bile duct stones (CBD) have had poor clinical uptake due to low accuracy. This study explores the challenges of developing and implementing a machine-learning model for the prediction of CBD stones i...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-020-05820-8

    authors: Tranter-Entwistle I,Wang H,Daly K,Maxwell S,Connor S

    更新日期:2021-02-01 00:00:00

  • Surgical outcomes after resection of both hepatic and pulmonary metastases from colorectal cancer.

    abstract:BACKGROUND:The efficacy and the indications of resection of synchronous or metachronous hepatic and pulmonary metastases from colorectal cancer (CRC) are controversial. This study retrospectively reviewed the cases of CRC patients who underwent both liver and lung resection to define the appropriate indications for sur...

    journal_title:World journal of surgery

    pub_type: 杂志文章

    doi:10.1007/s00268-012-1708-8

    authors: Sakamoto Y,Sakaguchi Y,Oki E,Minami K,Toh Y,Okamura T

    更新日期:2012-11-01 00:00:00