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.

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Chromium is one of the most significant metals used in the industry. There are many techniques for treating different types of industrial waste water that include chromium ion. In this study, the authors successfully adsorbed the chromium ion from alkaline aqueous solutions using different prepared types of chitosan as adsorbent materials. For the simultaneous sorption behaviour, the adsorption potential of the produced adsorbent was investigated for Cr+6 in a batch system. Natural chitosan was extracted from shrimp shell as it contains about 8–10% chitin which is used in the production of chitosan. The removal percentage of Cr+6 reached 99% after grafting natural and commercial chitosan at specific conditions. Several isotherm models have been used for mechanistic studies. The results indicated that the adsorption data for commercial chitosan is well-fitted by the Freundlich isotherm, Langmuir for commercial grafted, natural and natural grafted chitosan. Kinetic and equilibrium studies showed that the experimental data of Cr+6 were better described by the pseudo-first-order model for commercial chitosan and fitted the pseudo-second-order model for different types of chitosan used. Significantly, in order to scale this effective strategy on an industrial scale, response surface methodology (RSM) was used as a modelling tool to optimise process parameters such as ion concentrations, utilising Statistica Software.