Gaba Faiza, Ash Karen, Blyuss Oleg, Bizzarri Nicolò, Kamfwa Paul, Saiz Allison, Cibula David
Department of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK.
Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK.
Cancers (Basel). 2023 Oct 16;15(20):5001. doi: 10.3390/cancers15205001.
Gynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variation in post-operative morbidity and mortality following gynaecological oncology surgery between HIC and LMIC settings. Study design consisted of a multicentre, international prospective cohort study of women undergoing surgery for gynaecological malignancies (NCT04579861). Multilevel logistic regression determined relationships within three-level nested-models of patients within hospitals/countries. We enrolled 1820 patients from 73 hospitals in 27 countries. Minor morbidity (Clavien-Dindo I-II) was 26.5% (178/672) and 26.5% (267/1009), whilst major morbidity (Clavien-Dindo III-V) was 8.2% (55/672) and 7% (71/1009) for LMICs/HICs, respectively. Higher minor morbidity was associated with pre-operative mechanical bowel preparation (OR = 1.474, 95%CI = 1.054-2.061, = 0.023), longer surgeries (OR = 1.253, 95%CI = 1.066-1.472, = 0.006), greater blood loss (OR = 1.274, 95%CI = 1.081-1.502, = 0.004). Higher major morbidity was associated with longer surgeries (OR = 1.37, 95%CI = 1.128-1.664, = 0.002), greater blood loss (OR = 1.398, 95%CI = 1.175-1.664, ≤ 0.001), and seniority of lead surgeon, with junior surgeons three times more likely to have a major complication (OR = 2.982, 95%CI = 1.509-5.894, = 0.002). Of all surgeries, 50% versus 25% were performed by junior surgeons in LMICs/HICs, respectively. We conclude that LMICs and HICs were associated with similar post-operative major morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention.
与高收入国家（HICs）相比，低收入和中等收入国家（LMICs）的女性患妇科恶性肿瘤的比例要高得多，而全球癌症护理在可及性、质量和治疗结果方面的差异却鲜为人知。我们的研究旨在评估HICs和LMICs环境下妇科肿瘤手术后的国际术后发病率和死亡率差异。研究设计包括一项多中心、国际前瞻性队列研究，研究对象为接受妇科恶性肿瘤手术的女性（NCT04579861）。多水平逻辑回归确定了医院/国家内患者的三级嵌套模型中的关系。我们从27个国家的73家医院招募了1820名患者。低收入和中等收入国家（LMICs）的轻微发病率（Clavien-Dindo I-II）分别为26.5%（178/672）和26.5%（267/1009），而严重发病率（Clavien-Dindo III-V）分别为8.2%（55/672）和7%（71/1009）。较高的轻微发病率与术前机械肠道准备（OR = 1.474，95%CI = 1.054 - 2.061，P = 0.023）、手术时间较长（OR = 1.253，95%CI = 1.066 - 1.472，P = 0.006）、失血量较大（OR = 1.274，95%CI = 1.081 - 1.502，P = 0.004）有关。较高的严重发病率与手术时间较长（OR = 1.37，95%CI = 1.128 - 1.664，P = 0.002）、失血量较大（OR = 1.398，95%CI = 1.175 - 1.664，P≤0.001）以及主刀医生的资历有关，初级医生发生严重并发症的可能性是资深医生的三倍（OR = 2.982，95%CI = 1.509 - 5.894，P = 0.002）。在所有手术中，低收入和中等收入国家（LMICs）分别有50%和25%的手术由初级医生进行。我们得出结论，低收入和中等收入国家（LMICs）与术后严重发病率相似。将患者从手术并发症中挽救出来的能力是进行有意义干预的一个切实机会。
