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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<0·0001), adoption of intraoperative safety and communication strategies (0·87 [0·79–0·96]; p=0·0046), and on-site CT diagnostics (0·79 [0·65–0·97]; p=0·0220). Training facilities showed the greatest benefit in hospitals with limited infrastructure and an inexperienced workforce: the number needed to treat to prevent a procedure-specific complication was 21 (95% CI 14–35; p<0·0001). Interpretation: Safe implementation of minimally invasive surgery varies widely worldwide but is not defined by national income level; differences in outcomes reflect the ability of health systems to adopt and safely deploy new surgical techniques. We identified for the first time that the presence of local simulation-based training facilities is independently associated with improved patient outcomes. Simulation appears to be fundamental to the safe delivery of minimally invasive surgery, particularly in resource-constrained settings. Together with safety systems and diagnostic capacity, these findings offer actionable targets for health systems seeking to equitably scale up essential surgical technologies. Funding: NIHR Global Health Research Unit and Wellcome Leap SAVE Programme.
Safety and equity in scaling minimally invasive surgery worldwide in 109 countries using cholecystectomy as a tracer procedure: a prospective cohort study
Kamarajah S. K.;Kouli O.;Ng W. H.;Pius R.;Shaw C.;Ademuyiwa A.;Adisa A. O.;Agbeko A. E.;Aguielera M. L.;Alves M. S.;Atun R.;Aregawi A. B.;Bhangu A. A.;Cameron M.;Clark N.;Crawford R.;Dawson A. C.;Elhadi M.;Gallo G.;Gao J.;Ghosh D.;Gunn E. G. M.;Haque P. D.;Isik A.;Jiwa A.;Knight S.;Lawani I.;Lawani S.;Martin J.;Meara J. G.;Minaya Bravo A.;Morton D. G.;Ntirengaya F.;Pata F.;Picciochi M.;Price R.;Primrose J.;Roy N.;Tabiri S.;Varghese C.;Griffiths E. A.;Ramos-De la Medina A.;Badran D.;Chaudhry D.;Dermanis A.;Evans R. P. T.;Kehoe L.;Spiers H.;Thorne T.;To N.;Dajti I.;Djama Z.;Avellaneda N.;Palacios M.;Ingmar K.;Bayramov N.;Rahat E.;Adamovich D. M.;Eker H.;Bokossa C.;Delibegovic S.;Coimbra F.;Dardanov D.;Sanou A.;Sanou A. F.;Mbonicura J. C.;Nwegbu C.;Yang B.;Calvache J. A.;Mihanovic J.;Gouvas N.;East B.;Batista S.;Campuzano N.;Lincango E.;Emile S.;Reitano E.;Boumas N.;Demetrashvili Z.;Kamphues C.;Acquaye J.;Katsaros I.;Tsoulfas G.;Futaba K.;Zaránd A.;Moller P.;Dhiman J.;Suroy A.;Ryalino C.;Tahmasebi H.;Ali H.;Stephens I.;Marom G.;Hashimoto D.;Ayasra F.;Fakhradiyev I.;Hisham I.;Alherz M.;Ivanovs I.;Dulskas A.;Rosso E.;Chik I.;Duran I.;Fragosso M.;Martinez L.;Erdene S.;Houmada A.;Nashidengo P. R.;Schok T.;Chu M. J. J.;Wright D.;Risteski T.;Holte S.;Al-balushi Z.;Qureshi A. U.;Abu-Arish H.;Cukier M.;Gomez H.;Mendiola G.;Sacdalan M. D.;Krawczyk W.;Negoi I.;Butyrskii A.;Mushabab A.;Radenkovic D.;Wijerathne S.;Kosir J. A.;Ahmed A.;Kloppers C.;Wickramasinghe D.;Fadlalmola H.;Nikberg M.;Gialamas E.;Albared S. M.;Mbwele B.;Techapongsatorn S.;Hasnaoui A.;Mubezzi I.;Chooklin S.;Suhool A.;Horesh N.;Zaky O. B.;Nguyen T. V.;Al-Shehari M.;Abbasov A.;Abd Elrahman A. A. E. A.;Abd-Errazik M.;Abdelkabir M.;Abdelmohsen S.;Abdelrahman A. S. M.;Abdelsamad. A.;Abdelwahab A.;Abdul Rahim A. F.;Abdulwahed E.;Abdurrazzaaq A.;Abellera J. M. I.;Aberra Y.;Abouelnagah G.;Abozid A.;Abozied H.;Abuobaida Banaga Hag El Tayeb E. E.;Acosta Cumberbatch L. E.;Acquah E.;Adam A. A.;Adegbola S.;Adel I.;Adem S.;Adepoju O.;Adeyeye A.;Aeschbacher P.;Afif Zain E.;Agbonrofo P.;Agrawal M. K.;Aguado López H.;Aguilar J.;Aguilar Preciado I. H.;Aguilar-Espinosa F.;Ahmad Zaidi A. A. H.;Ahmed E. A.;Ahmed Z.;Ahmed S.;Ahmed H.;Ahmed I. M. G.;Ahmed Elamin Elnour M. A.;Ahmed Rashid A.;Aiolfi A.;Akwaisah A.;Al Riyami S.;Al Sakini A.;Al-Aamri H.;Al-Dhaheri M.;Al-Fandi A.;Al-Juaifari M. A.;Al-Mallah A.;Al-Sarireh B.;Alalawi Y.;Alali M.;Alananzeh S.;Albendary M.;Aleem M.;Alexander P.;Alfaro Varela J. C.;Alhamss A.;Alharmoodi F.;Alharthi M.;Alhello A.;Ali I.;Ali Alwah H.;Aliosin O.;Aljorfi A.;Alkaseek A.;Alkhayat A.;Almeida K.;Almoshantaf M. B.;Almunifi A.;Alnasser M.;Alnees M.;Alrashidi O.;Alrayes B.;Alsabe L.;Alsaleem H.;Alshaikh B.;Altayyeb A. A. A.;Altheyab F.;Altinel Y.;Alvarez A.;Alvarez Sores E. D.;Alwi A. F. M.;Alzerwi N.;Amato L.;Ambrazevicius M.;Amico F.;Amisano M. F.;Amjad N. M.;Ammar A. S.;Ammerata G.;Andolfi E.;Andreuccetti J.;Andriola V.;Angelico R.;Ansaloni L.;Antonio A.;Anwar S. L.;Anyanwu L. -J.;Apollos J. R.;Apostolou C.;Aquilino F.;Arana Reyes J. C.;Ardhanari R.;Aremu M.;Aremu I. I.;Argenio G.;Armah R.;Arnalsteen L.;Arnaud A. P.;Arroyo Basto C.;Arshad R.;Arya P. K.;Asare O.;Ascari F.;Asenov Nikolov Y.;Ashraf F.;Askari A.;Asla A.;Aslanidis T.;Asokumar S.;Asumanu E.;Atasoy D.;Athwal T.;Attri A.;Avella P.;Avila Mercado O.;Awad S. S.;Azevedo P.;Baba S.;Bacalbasa N.;Baculi R.;Badiani S.;Baiocchi G. L.;Bajubair E.;Baker E.;Baki B. E.;Bakri A.;Balakrishnan S.;Balciscueta Z.;Baldini E.;Balduzzi A.;Ballabio M.;Balogun O.;Bangeas P.;Baraket O.;Baravalle M.;Barberis A.;Barcelona M. D.;Baronio G.;Bashir G.;Basso S. M. M.;Batool F.;Bawa A.;Bayrak M.;Bačak Kocman I.;Bedzhanyan A.;Beji H.;Bekele A.;Bekele P.;Belchita R.;Belgaumkar A.;Belouz R.;Beltran Miranda P.;Ben Dhaou A.;Ben Hasan N.;Ben Khalifa M.;Ben Safta A.;Bennett S.;Bensaad A.;Berevoescu N. -I.;Bergna A.;Beristain-Hernandez J. -L.;Bermudez Ruiz J. D. R.;Bernabé Esteban A. A.;Bernardi D.;Berrami R.;Bertoglio C. L.;Betalleluz Pallardel J.;Bhandari B.;Bhattacharya K.;Bhatti K.;Bhatti H. W.;Bhutia K.;Bianco A.;Bickford M.;Bielka K.;Bilat R.;Bileid Bakeer H.;Biloslavo A.;Bitunjac K.;Bocchino A.;Bogani G.;Bogdan M.;Bogdanic B.;Bokhari M. H. T.;Bolivar Saenz D.;Bollino R.;Bond-Smith G.;Borda-Luque G.;Borowski D. W.;Bortolasi L.;Bottari A.;Bouchagier K.;Bouchentouf S. M.;Bouziane M.;Braat A.;Bradshaw L.;Brahmachari S.;Brolese A.;Brucchi F.;Bubenova M.;Bufalari A.;Bui V. D. A.;Buitendag J. J. P.;Bulbuloglu G. C.;Bulian D. R.;Buna-Arvinte M.;Burbano Andrade G. A.;Bwala K. J.;Börner N.;Cakcak I. E.;Callcut R.;Calvo Espino P.;Cammarata F.;Campero Y. A.;Canonico G.;Cantürk A. Ö.;Capkinoglu E.;Capolupo G. T.;Capozzi P.;Carbone L.;Carbonell-Morote S.;Cardona Gomez D. C.;Catena F.;Cazador Labat M.;Cecconi C.;Cestaro G.;Chakravartty S.;Chandrasinghe P.;Chauhan M.;Chavez Quispe L. N.;Chavkin P.;Chawla T.;Cheng E.;Cherchi V. A.;Cheung Y. S.;Chin T.;Chiozza M.;Choudhry A.;Chouliaras C.;Chow T. C. -M.;Chowdhury S.;Christodoulidis G.;Christodoulou P.;Christou N.;Chukwu I.;Chávez Pacheco J.;Cianci P.;Cillara N.;Cinquepalmi M.;Citgez B.;Clarizia G.;Clementi M.;Cocorullo G.;Colak E.;Coletta D.;Colonna E.;Contreras J. R.;Cordera F.;Costa-Maia J.;Costas-Chavarri A.;Creanga M.;Cresswell A.;Cribb B.;Crétolle C.;Cucoreanu C.;Cueva M.;Cunningham S.;Curletti G.;Currie A.;D’acapito F.;D’ugo S.;Dajani K.;Danko J.;Daraghmeh L.;Date R.;Davidson B.;Davison S.;Dbouk S.;De Andrés-Asenjo B.;De Capua M.;De Carlis R.;De La Serna Esteban S.;De Nardi P.;De Simone B.;De Vincenti R.;Dede K.;Dedemadi G.;Deiro G.;Del Basso C.;Del Fabbro D.;Delis S.;Demirli Atici S.;Demirpolat M. T.;Denys Fabrice B.;Desalegn K.;Deshmukh P.;Devar J.;Dharap S.;Di Carlo I.;Di Maggio F.;Di Marco F.;Di Mauro D.;Di Saverio S.;Diab R.;Diamantis A.;Diaz A.;Dib Hasan J.;Dilevska T.;Dimitriou N.;Dimova A.;Dindyal S.;Dinçer B.;Donchev R.;Dowgiałło-Gornowicz N.;Drogouti M.;Dugar D.;Duro A.;Duttaroy D.;Dyer E.;Däster S.;Díaz Pedrero R.;Earjala J. K.;Efetov S.;Egreara S.;Ekwunife O. H.;Ekwunife C.;El Boghdady M.;El Ghali M. A.;El Helou E.;El Magrahi H.;El-Kassas M.;El-Sharkawy A.;Elbe P.;Elemile P.;Elfiky M.;Elgendy H.;Elhajdawe F. A. D.;Elsahli S.;Elsayed A.;Elsayed M. M.;Elsheikh R.;Eltilib I.;Emran A.;Erdem O.;Erel S.;Erginöz E.;Erreguin Breña M.;Escartin J.;Espinosa-Hinojosa A.;Estaire Gómez M.;Evola G.;Ezomike U.;Fabbri N.;Fahmy B.;Fairfield C. J.;Fajardo Gomez R.;Fakoya A.;Fanta E.;Fappiano F.;Farhan M. A. T.;Fassari A.;Fasting M.;Fayyaz M. A.;Fendri S.;Fergusson S.;Fernandes P. H. D. S.;Fernandes C.;Fernandez Rodriguez M.;Fernández Camuñas Á.;Ferrario L.;Fialho G.;Figueira A.;Filardo M.;Filippou N.;Fiorentini G.;Fleres F.;Flores Chávez L. A.;Flores Mena M.;Florez Farfan E. S.;Folek J.;Fortuna L.;Fortuna Martins S.;Foss H.;Franczak P.;Frankel A.;Franklin K.;Freitas A.;Fremdling C.;Frena A.;Fretland Å. A.;Fugărețu C.;Fujiwara K.;Gaitán Buitrago M. H.;Galleano R.;Gama B.;Gambardella D.;Garcia Covarrubias L.;García Agudelo L.;Garmanova T.;Garosio I.;Gasakure M.;Gass J. -M.;Gbessi G.;Gebremeskel Z.;Gelmini R.;Gessesse G.;Ghannam W.;Giacometti M.;Ginghina O.;Giorgakis E.;Gkekas I.;Glowka T. R.;Gobbi A. A.;Gobishangar S.;Goel M.;Gokhare Viswanath N.;Goksoy B.;Gonzalez Ojeda A.;Gonzalez Suarez S.;Gonçalves N.;Gool F.;Gosselink M.;Govindarajan K. K.;Gracia-Roche C.;Granieri S.;Grasa González F.;Gray J.;Grieco M.;Grubor N.;Gu J.;Gudaityte R.;Gundara J.;Guner A.;Guo W. A.;Gupta R.;Gupta A.;Gupta S. K.;Gupta N.;Gårdmark H.;Gómez Herrera M. N.;Gómez López J. R.;Hackner D.;Hadrich Z.;Hadzhiev D.;Haffreingue A.;Hager B.;Hamdi A.;Hamed H.;Hannon R.;Hansen L.;Haraldsdóttir K. H.;Haraux E.;Hardon S.;Hasanov A.;Haseeb A.;Hawkins W.;Henriques C.;Herczeg G.;Hernández Vázquez A.;Hetta H. F.;Heynderickx L.;Hinojosa Ugarte D.;Hodgson R.;Hollyman M.;Holroyd D.;Hommann M.;Houssem A.;Hristova E.;Huamani Tipian E. J.;Huaroto Landeo C. F.;Huber C.;Hudson P.;Hugh T. J.;Hureibi K.;Hutton M.;Höhn P.;Iacob G.;Iahmo T.;Ibarra J.;Ibrahim A.;Idiz U. O.;Ietto G.;Iftikhar M.;Iliev I.;Incollingo P.;Ioannidis O.;Iossa A.;Iqbal M. Z.;Isaacs Beron R.;Isazade E.;Ismail M.;Iswariah H.;Itani R.;Iwao Y.;Izzo M.;Jaffer A.;Jaffry K.;Jameel M. K.;Jawad M.;Jayakrishnan R.;Jayathilake A.;Jean Léon Olory Togbe T.;Jelinek P.;Jimenez Flores J. A.;Jiménez Carneros V.;Jinadasa S.;Jindani R.;Jog S.;Joksimovic V.;Joliat G. -R.;Jolly H.;Jomaa S.;Jones S.;Jose P.;Julianov A.;Kafui Ayodeji E.;Kakotkin V.;Kale S.;Kalopita K.;Kalyanapu J. A.;Kamal H.;Kambouri K.;Kamer E.;Kanakaratne S.;Kapoor A.;Kapsampelis P.;Kapuge L.;Kara Y.;Karagiannidis G.;Karakosta A.;Karakuş Bozkurt Ş.;Karamanliev M.;Karamarkovic A.;Karantenachy A. K. A.;Karim S.;Karimian F.;Katorkin S. E.;Kaups K.;Kaushal D.;Kazakov I.;Kechagias A.;Kelly M.;Kenawadekar R.;Khalid J.;Khalilov Z.;Khaliq T.;Khamees A.;Khan K. S.;Khan M. U.;Kilani A. I.;Kilinc Tuncer G.;Kipenska E.;Kirchweger P.;Kirengo T.;Kirimker E. O.;Kiziltoprak N.;Klib M.;Kocher H. M.;Kocman Panić M.;Koh P. S.;Kokoropoulos P.;Kong K.;Konstadoulakis M.;Konswa S.;Kontis E.;Kontzoglou K.;Kopljar M.;Korkolis D.;Koronakis N.;Koukoulis G.;Kovalska I.;Kovačević M.;Krichen J.;Krishnappa N.;Kryvoruchko I. A.;Kulimbet M.;Kulkarni S.;Kumar A.;Kumar M.;Kumar Venkatappa S.;Kuriyama A.;Kvietkauskas M.;Kyriakidis A.;Labalde Martinez M.;Lal P.;Lam Y. H.;Lapitan M. C.;Lapolla P.;Latif S.;Lau N. -S.;Lazarus E.;Leake P. -A.;Leaning M.;Leblebici M.;Lee C. H. A.;Lee M. S.;Lee A.;Legge-Wilkinson H.;Leichtle S.;Lepre L.;Leung E.;Leventoglu S.;Li A.;Liang R.;Licari L.;Lim C. S. H.;Lim Y. P.;Lin A.;Ling L. L. L. L.;Litescu M.;Lizzi V.;Locci E.;Logedi V.;Lokesh B.;Lopez Flores S.;Losada M.;Louro J.;Loveday B.;Luglio G.;Lule H.;Lunca S.;Lunevicius R.;Luzzi A. -P.;Lytras D.;Mabogoane T.;Mabood W.;Macchitella Y.;Mach C.;Macutkiewicz C.;Madabhavi I.;Magnone S.;Magwesela F.;Mahakalkar C.;Maher A.;Mahmood F.;Maiga A.;Maithel S.;Maiyauen T. K.;Majeed S.;Majid A.;Makama J. G.;Makhmudov A.;Malik M.;Mallmann C.;Mamadou P.;Manatakis D. K.;Mansour O.;Manzoor S.;Maqueda R.;Marafante C.;Marique L.;Markov P.;Marquez L.;Marson F. A. L.;Martin-Perez E.;Martinez Gomez J. D.;Marçal A.;Mascagni P.;Massaferro G.;Mathew S.;Matkovic Z.;Matyja M.;Mazzoni A.;Mcclen R.;Mcdonnell D.;Mcgee R.;Mckenzie K.;Mcmahon M.;Mejia De La Cruz D.;Mejia Flores E. R.;Melkamu B. E.;Memiş U.;Memişoğlu E.;Mendoza Arango M. C.;Mengers J.;Menzulin R.;Merene M.;Merlini D.;Merlo I. G.;Mersil M.;Mesfin Nigussie M.;Messner F.;Mikula-Noble N.;Min J. G.;Minguez J.;Minicozzi A.;Miranda Pera R.;Mireles V. A.;Mishra T. S.;Mishra H. C.;Miskovic J.;Mitrovic N.;Mittal R.;Mlotshwa M.;Mohamad I.;Mohamad B.;Mohamed Ahmed E. D.;Mohamed Hassan Abdul-Aziz D.;Mohamed Ibrahim Mohamed A.;Mohammad S.;Mohammed M. M. H.;Mohammed Bello U.;Mohamud A. A.;Moksia I.;Molewa C.;Mongelli F.;Montal S.;Monteiro R.;Mooney J.;Mora Oliver I.;Morabito M.;Morales X.;Moravik J.;Morelli L.;Moreno-Licea C.;Moretti M.;Morgan E.;Mpirimbanyi C.;Mtshali T.;Muhammed B.;Mukherjee I.;Munir M.;Munoz-Maldonado G. E.;Muralidharan V.;Muratore A.;Musa Umar B.;Muscarella P.;Mutafchiyski V.;Muthu S.;Nadal L. R.;Nagadya C.;Nahalka D.;Nahm C.;Naidu K.;Naim D.;Nair S.;Namugenyi C.;Nandasena M.;Napan Villa J. M.;Napetti S.;Napolitano L.;Nardo B.;Nasani M.;Nassour I.;Navaratne L.;Navarrete-Peón A.;Nawacki Ł.;Nazareth F.;Ndizeye O.;Neric J. A.;Nezi G.;Ng J.;Ng S. H. M.;Ng E. H. B.;Ngotho O. H.;Nidaw M.;Nikaj H.;Nikolouzakis T.;Nnaji C.;Nobori C.;Noel R.;Noel C.;Noor M.;Noor Mohamed M. S.;Nortey M.;Novikova A.;Novruzov N.;Ntourakis D.;Nunes Coelho M.;Nuño-Guzmán C. M.;O’brien S.;O’connor Z.;O’neill A.;Obando Cazorla J. G.;Oikonomou I. M.;Okereke C.;Okunlola A. I.;Olaogun J.;Olaomi O.;Olayiwola D. O.;Oliveira S.;Oliver Guillen J. R.;Olmez T.;Olmi S.;Omar M.;Omar B.;Omer F. E.;Ong C. S.;Oommen A. N.;Oosterkamp A.;Ordaz K.;Ortega Vázquez I.;Ortenzi M.;Orzeszko Z.;Osorio Flórez D.;Otamendi-Galan D. A.;Otokwala J.;Ouyahia A.;Owusu F.;Pan D.;Panduro-Correa V.;Panis C.;Pantoja Pachajoa D. A.;Papadopoulos A.;Papavramidis T.;Parker R.;Parmar C.;Parray F. Q.;Patel P.;Patel A.;Patell N.;Patij J.;Patnaik P.;Patrick U.;Patrone R.;Peckham-Cooper A.;Perekhodov S.;Peres C.;Perez A.;Perez Rivera C. J.;Perkins L.;Peros G.;Perrone F.;Pesenti G.;Petrone P.;Petrucciani N.;Piazza L.;Picardi B.;Picchio M.;Piccoli M.
2026-01-01
Abstract
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<0·0001), adoption of intraoperative safety and communication strategies (0·87 [0·79–0·96]; p=0·0046), and on-site CT diagnostics (0·79 [0·65–0·97]; p=0·0220). Training facilities showed the greatest benefit in hospitals with limited infrastructure and an inexperienced workforce: the number needed to treat to prevent a procedure-specific complication was 21 (95% CI 14–35; p<0·0001). Interpretation: Safe implementation of minimally invasive surgery varies widely worldwide but is not defined by national income level; differences in outcomes reflect the ability of health systems to adopt and safely deploy new surgical techniques. We identified for the first time that the presence of local simulation-based training facilities is independently associated with improved patient outcomes. Simulation appears to be fundamental to the safe delivery of minimally invasive surgery, particularly in resource-constrained settings. Together with safety systems and diagnostic capacity, these findings offer actionable targets for health systems seeking to equitably scale up essential surgical technologies. Funding: NIHR Global Health Research Unit and Wellcome Leap SAVE Programme.
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<0·0001), adoption of intraoperative safety and communication strategies (0·87 [0·79-0·96]; p=0·0046), and on-site CT diagnostics (0·79 [0·65-0·97]; p=0·0220). Training facilities showed the greatest benefit in hospitals with limited infrastructure and an inexperienced workforce: the number needed to treat to prevent a procedure-specific complication was 21 (95% CI 14-35; p<0·0001). Interpretation: Safe implementation of minimally invasive surgery varies widely worldwide but is not defined by national income level; differences in outcomes reflect the ability of health systems to adopt and safely deploy new surgical techniques. We identified for the first time that the presence of local simulation-based training facilities is independently associated with improved patient outcomes. Simulation appears to be fundamental to the safe delivery of minimally invasive surgery, particularly in resource-constrained settings. Together with safety systems and diagnostic capacity, these findings offer actionable targets for health systems seeking to equitably scale up essential surgical technologies.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12610/95724
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
