Safety and equity in scaling minimally invasive surgery worldwide in 109 countries using cholecystectomy as a tracer procedure: a prospective cohort study

Autor

Adesoji O. Ademuyiwa
Adewale O. Adisa
Afra Jiwa
Alazar Berhe Aregawi
Alex Dermanis
Amanda Caroline Dawson
Ana Minaya Bravo
Aneel Bhangu
Anita Eseenam Agbeko
Antonio Ramos-De la Medina
Arda Isik
Camilo Ramírez-Giraldo
Catherine A. Shaw
Chris Varghese
Dania Badran
Daoud Chaudhry
Dhruva Ghosh
Dion Morton
E. A. Griffiths
Eilidh G.M. Gunn
Faustin Ntirengaya
Francesco Pata
Gaetano Gallo
Harry Spiers
Ismaïl Lawani
Janet Martin
John G. Meara
John Primrose
Junyi Gao
Laura Kehoe
Mafalda Sampaio Alves
Malcolm Cameron
Maria Lorena Aguielera
Maria Picciochi
Muhammed Elhadi
Neil Clark
Nobhojit Roy
None None
Omar Kouli
Parvez David Haque
R. P.T. Evans
Raymond Price
Richard Crawford
Rifat Atun
Riinu Pius
S. K. Kamarajah
Souliath Lawani
Stephen Richard Knight
Stephen Tabiri
Wee Han Ng

Resumen

Summary Background: Minimally invasive surgery is rapidly expanding globally, yet there is insufficient knowledge of how to scale this technology safely and equitably across diverse health systems. We aimed to identify health-system factors associated with safe implementation of minimally invasive surgery globally, using minimally invasive cholecystectomy as a tracer procedure. Methods: We conducted a multicentre, prospective cohort study of consecutive adults undergoing cholecystectomy between July 31 and Nov 19, 2023, in 1218 hospitals across 109 countries. Data were collected by more than 10 000 health-care workers using a core measurement set mapped to the WHO Health System Building Blocks and the Global Patient Safety Action Plan. The primary outcome was 30-day procedure-specific complications, with multilevel logistic regression used to examine associations between health-system features and patient outcomes. This study is registered on ClinicalTrials.gov (NCT06223061). Findings: Among 52 187 included patients, the adjusted procedure-specific complication rate varied 40-fold between hospitals, from 0·3% in the lowest risk quintile to 12·1% in the highest risk quintile. Despite large structural differences across income groups in access to minimally invasive surgery, diagnostics, and emergency services, country income level was not independently associated with complication rates (adjusted odds ratio [OR] 0·81 [95% CI 0·59–1·10] for upper-middle income vs high income and 0·99 [0·70–1·39] for lower-middle income or low income vs high income). Three modifiable hospital-level factors were strongly associated with safer outcomes: establishment of local simulation-based training facilities (adjusted OR 0·78 [0·71–0·86]; p

autores

http://vivoweb.org/ontology/core#FacultyMember
Isaza Restrepo, Andrés

fecha de publicación

2026-2-1

Área temática

Salud y bienestar

Edición

Número Internacional Normalizado de Publicaciones Seriadas (ISSN)

2572-116X

Identificador de objeto digital (DOI)

https://doi.org/10.1016/s2214-109x(25)00476-0

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Safety and equity in scaling minimally invasive surgery worldwide in 109 countries using cholecystectomy as a tracer procedure: a prospective cohort study Artículo académico

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