With advances in the effectiveness of treatment and disease management, the contribution of chronic comorbid diseases (comorbidities) found within the Charlson comorbidity index to mortality is likely to have changed since development of the index in 1984. The authors reevaluated the Charlson index and reassigned weights to each condition by identifying and following patients to observe mortality within 1 year after hospital discharge. They applied the updated index and weights to hospital discharge data from 6 countries and tested for their ability to predict in-hospital mortality. Compared with the original Charlson weights, weights generated from the Calgary, Alberta, Canada, data (2004) were 0 for 5 comorbidities, decreased for 3 comorbidities, increased for 4 comorbidities, and did not change for 5 comorbidities. The C statistics for discriminating in-hospital mortality between the new score generated from the 12 comorbidities and the Charlson score were 0.825 (new) and 0.808 (old), respectively, in Australian data (2008), 0.828 and 0.825 in Canadian data (2008), 0.878 and 0.882 in French data (2004), 0.727 and 0.723 in Japanese data (2008), 0.831 and 0.836 in New Zealand data (2008), and 0.869 and 0.876 in Swiss data (2008). The updated index of 12 comorbidities showed good-to-excellent discrimination in predicting in-hospital mortality in data from 6 countries and may be more appropriate for use with more recent administrative data.

Background Surgery is a foundational component of health care systems. However, previous efforts to integrate surgical services into global health initiatives do not reflect the scope of surgical need and many health systems do not provide essential interventions. We estimate the minimum global volume of surgical need to address prevalent diseases in 21 epidemiological regions from the Global Burden of Disease Study 2010 (GBD). Methods Prevalence data were obtained from GBD 2010 and organized into 119 disease states according to the World Health Organization’s Global Health Estimate (GHE). These data, representing 187 countries, were then apportioned to the 21 GBD epidemiological regions. Using previously defined values for the incident need for surgery for each of the 119 GHE disease states, we calculate minimum global need for surgery based on the prevalence of each condition in each region. Results We estimate that at least 321·5 million surgical procedures would be needed to address the burden of disease for a global population of 6.9 billion in 2010. Minimum rates of surgical need vary across regions, ranging from 3,383 operations per 100,000 in Central Latin America to 6,495 operations per 100,000 in Western Sub-Saharan Africa. Global surgical need also varied across sub-categories of disease, ranging from 131,412 procedures for Nutritional Deficiencies to 45.8 million procedures in Unintentional Injuries. Conclusions The estimated need for surgical procedures worldwide is large and addresses a broad spectrum of disease states. Surgical need varies between regions of the world according to disease prevalence and many countries do not meet the basic needs of their populations. These estimates may be useful for policy makers, funders, and ministries of health as they consider how to incorporate surgical capacity into health systems.

No abstract

Follow-up strategies for patients treated for non-metastatic colorectal cancer.

Follow-up strategies for patients treated for non-metastatic colorectal cancer.