Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov , NCT03471494 . Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.

A case of repeated episodes of Pseudomonas vesicularis bacteraemia, in a 54-year-old woman with a past history including systemic lupus erythematosus and chronic active autoimmune hepatitis is reported. She was treated with tobramycin and ceftazidime but bacteraemia persisted until surgical resection of the infected tissue was performed.

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A total of 211 patients were admitted at the UP-PGH Burn Unit in 1995. Sixty-eight (32.2%) patients suffered burn injuries secondary to electrical injury. In the period from July to December 1995, a total of 28 patients were admitted because of burns caused by electricity. Twenty-six (92%) patients sustained injury secondary to high tension (> 1000 V) electrical current and 2 (7.1%) secondary to low tension (< 1000 V) electrical current, specifically 220 V, which were both self-inflicted. Twenty-seven (96%) patients were males. Injury was work-related in 18 patients, nonwork-related in 8, and self-inflicted in 2. Sixteen (57%) patients suffered injuries on a rooftop, 11 (39%) patients on the ground, and 1 (3.5%) patient on top of an electric post. A total of 22 operations were performed on 28 patients, including 7 extremity amputations, which makes an amputation rate of 25%. There were 5 deaths secondary to overwhelming wound sepsis, making an overall mortality rate of 21.7% and an operative mortality rate of 22.7%. The average length of hospital stay was 17.2 days.