Safety and equity in scaling minimally invasive surgery worldwide in 109 countries using cholecystectomy as a tracer procedure: a prospective cohort study.
作者：S. Kamarajah, Omar Kouli, W. Ng, R. Pius, Catherine Shaw, A. Ademuyiwa, A. Adisa, A. E. Agbeko, Maria Lorena Aguielera, M. Alves, R. Atun, A. Aregawi, A. Bhangu, M. Cameron, N. Clark, R. Crawford, A. C. Dawson, M. Elhadi, G. Gallo, Junyi Gao, D. Ghosh, Eilidh G. M. Gunn, P. Haque, Arda Isik, Afra Jiwa, Stephen R. Knight, I. Lawani, S. Lawani, Janet Martin, John G. Meara, A. Minaya Bravo, Dion G. Morton, Faustin Ntirengaya, F. Pata, M. Picciochi, Raymond S. Price, John Primrose, Nobhojit Roy, S. Tabiri, C. Varghese, E. Griffiths, A. Ramos-De la Medina, D. Badran, D. Chaudhry, A. Dermanis, R. Evans, Laura Kehoe, Harry V. M. Spiers, T. Thorne, N. To, I. Dajti, Z. Djama, Nicolás Avellaneda, Manuel Palacios, Konigsrainer Ingmar, N. Bayramov, Ehsan Rahat, Dmitry M. Adamovich, Hasan Eker, C. Bokossa, Samir Delibegović, Felipe Coimbra, D. Dardanov, Adama Sanou, A. Sanou, J. Mbonicura, C. Nwegbu, Baohong Yang, J. A. Calvache, J. Mihanovic, N. Gouvas, B. East, S. Batista, N. Campuzano, E. Lincango, S. Emile, E. Reitano, N. Boumas, Z. Demetrashvili, C. Kamphues, Jane Acquaye, I. Katsaros, Georgios Tsoulfas, K. Futaba, A. Zaránd, P. Møller, J. Dhiman, A. Suroy, Christopher Ryalino, Hamed Tahmasebi, H. Ali, I. Stephens, G. Marom, D. Hashimoto, F. Ayasra, I. Fakhradiyev, I. Hisham, M. Alherz, I. Ivanovs, A. Dulskas, E. Rosso, I. Chik, I. Duran, Melissa Fragosso, L. Martinez, S. Erdene, A. Houmada, P. Nashidengo, T. Schok, Michael Jen Jie Chu, Deborah Wright, T. Risteski, Silje Holte, Zainab Al-balushi, A. Qureshi, H. Abu-Arish, M. Cukier, Hugo Gomez, G. Mendiola, M. D. Sacdalan, W. Krawczyk, I. Negoi, A. Butyrskii, Alshahrani Mushabab, D. Radenkovic, S. Wijerathne, J. Košir, Abdisamed Ahmed, C. Kloppers, D. Wickramasinghe, H. Fadlalmola, M. Nikberg, E. Gialamas, S. M. Albared, B. Mbwele, S. Techapongsatorn, A. Hasnaoui, Isaac Mubezzi, S. Chooklin, Amal Suhool, N. Horesh, Osama Bahsas Zaky, T. Nguyen, M. Al-Shehari, A. Abbasov, A. A. Abd Elrahman, M. Abd-erRazik, M. Abdelkabir, S. Abdelmohsen, A. Abdelrahman, A. Abdelsamad, Ahmed Abdelwahab, A. F. Abdul Rahim, E. Abdulwahed, Abdussemee Abdurrazzaaq, J. M. Abellera, Y. Aberra, G. Abouelnagah, A. Abozid, H. Abozied, Essam Eldien Abuobaida Banaga Hag El Tayeb, Luis Enrique Acosta Cumberbatch, E. Acquah, A. A. Adam, S. Adegbola, I. Adel, Safia Adem, O. Adepoju, A. Adeyeye, P. Aeschbacher, Effa Afif Zain, P. Agbonrofo, M. K. Agrawal, H. Aguado López, José Aguilar, Irving Hugo Aguilar Preciado, F. Aguilar-Espinosa, A. A. H. Ahmad Zaidi, E. A. Ahmed, Z. Ahmed, Salma Ahmed, H. Ahmed, I. Ahmed, Mohey Aldien Ahmed Elamin Elnour, Amiin Ahmed Rashid, A. Aiolfi, Ayoub Akwaisah, S. Al Riyami, A. A. Al Sakini, H. Al-Aamri, M. Al-Dhaheri, A. Al-Fandi, M. Al-Juaifari, Abdullah Al-Mallah, B. Al-Sarireh, Yousef Alalawi, Mohammed N. Alali, S. Alananzeh, M. Albendary, Muhammad Aleem, P. Alexander, Julio Cesar Alfaro Varela, Ahmed Alhamss, F. Alharmoodi, M. Alharthi, A. Alhello, Irfan Ali, Haithm Ali Alwah, O. Aliosin, A. Aljorfi, A. Alkaseek, Ali Alkhayat, K. Almeida, M. B. Almoshantaf, Abdullah Almunifi, Mohammed Alnasser, M. Alnees, Othman Alrashidi, B. Alrayes, Lana Alsabe, H. Alsaleem, B. Alshaikh, Ahmed Albagir Ali Altayyeb, Fatemah Altheyab, Y. Altinel, A. Alvarez, E. D. Alvarez Sores, Ahmad Fais Mukriz Alwi, N. Alzerwi, Lavinia Amato, M. Ambrazevicius, F. Amico, M. Amisano, N. Amjad, Ahmed Siddique Ammar, G. Ammerata, E. Andolfi, J. Andreuccetti, V. Andriola, Roberta Angelico, Luca Ansaloni, Amato Antonio, S. L. Anwar, L. Anyanwu, Jeyakumar R. Apollos, C. Apostolou, Fabrizio Aquilino, Juan Carlos Arana Reyes, Ramesh Ardhanari, Muyiwa Aremu, I. Aremu, Giulio Argenio, R. Armah, L. Arnalsteen, A. P. Arnaud, Carlos Arroyo Basto, R. Arshad, P. Arya, O. Asare, F. Ascari, Yavor Asenov Nikolov, Fariha Ashraf, A. Askari, A. Asla, Theodoros Aslanidis, Sivananthan Asokumar, E. Asumanu, Deniz Atasoy, T. Athwal, A. Attri, P. Avella, Octavio Avila Mercado, Selmy S Awad, P. Azevedo, Suleiman Baba, N. Bacalbasa, Roselyn Baculi, S. Badiani, G. Baiocchi, Emad Bajubair, E. Baker, B. Baki, A. Bakri, Sankar Balakrishnan, Z. Balciscueta, E. Baldini, A. Balduzzi, M. Ballabio, O. Balogun, P. Bangeas, O. Baraket, Manuel Baravalle, A. Barberis, M. D. Barcelona, G. Baronio, G. Bashir, S. Basso, Fizza Batool, A. Bawa, M. Bayrak, Iva Bačak Kocman, A. Bedzhanyan, H. Beji, A. Bekele, Philimon Bekele, Raluca Belchita, A. Belgaumkar, R. Belouz, Pablo Beltran Miranda, A. Ben Dhaou, N. Ben Hasan, Mohamed Aymen Ben Khalifa, A. ben Safta, S. Bennett, A. Bensaad, N. Berevoescu, A. Bergna, J. Beristain-Hernández, Judith Del Rosario Bermudez Ruiz, Aguilar Ayala Bernabé Esteban, Daniele Bernardi, Rania Berrami, C. Bertoglio, J. Betalleluz Pallardel, Binod Bhandari, Kaushik Bhattacharya, K. Bhatti, H. Bhatti, K. Bhutia, A. Bianco, M. Bickford, K. Bielka, Radosław Bilat, H. Bileid Bakeer, A. Biloslavo, Kristina Bitunjac, A. Bocchino, G. Bogani, M. Bogdan, B. Bogdanić, M. H. T. Bokhari, Dinimo Bolivar Saenz, R. Bollino, G. Bond-Smith, Giuliano Borda-Luque, David W Borowski, L. Bortolasi, A. Bottari, K. Bouchagier, Sidi Mohammed Bouchentouf, M. Bouziane, A. Braat, Luke Bradshaw, Swagata Brahmachari, A. Brolese, F. Brucchi, M. Bubenova, Andrea Bufalari, V. Bui, J. Buitendag, Guney Cem Bulbuloglu, D. Bulian, Mihaela Buna-Arvinte, Gissel Alejandra Burbano Andrade, K. Bwala, N. Börner, I. Cakcak, R. Callcut, P. Calvo Espino, Francesco Cammarata, Yanet Andrea Campero, G. Canonico, A. Cantürk, E. Çapkınoğlu, G. Capolupo, Patrizia Capozzi, L. Carbone, Silvia Carbonell-Morote, Diana Catalina Cardona Gómez, F. Catena, M. Cazador Labat, C. Cecconi, G. Cestaro, S. Chakravartty, P. Chandrasinghe, Munish Chauhan, Lizeth Norka Chavez Quispe, P. Chavkin, T. Chawla, Elaine Y. Cheng, V. Cherchi, Yue-Sun Cheung, Theresa Chin, M. Chiozza, A. Choudhry, C. Chouliaras, T. Chow, Sharfuddin Chowdhury, Gregorios Christodoulidis, Prokopis Christodoulou, N. Christou, I. Chukwu, J. Chávez Pacheco, P. Cianci, N. Cillara, Matteo Cinquepalmi, B. Çitgez, G. Clarizia, M. Clementi, G. Cocorullo, Elif Colak, D. Coletta, E. Colonna, J. Contreras, F. Cordera, J. Costa-Maia, A. Costas-Chavarri, M. Creanga, Andy Cresswell, B. Cribb, C. Crétolle, Ciprian Cucoreanu, M. Cueva, S. Cunningham, G. Curletti, Andrew Currie, F. D’acapito, S. D’ugo, K. Dajani, Jan Danko, Laith Daraghmeh, R S Date, Brian Davidson, S. Davison, S. Dbouk, B. De Andrés-Asenjo, M. De Capua, R. De Carlis, S. de la Serna Esteban, P. De Nardi, B. de Simone, R. De Vincenti, Kristof Dede, G. Dedemadi, Giacomo Deiro, C. Del Basso, D. Del Fabbro, Spiros Delis, S. Demirli Atıcı, M. T. Demirpolat, Busomoke Denys Fabrice, Kibruyisfa Desalegn, Parikshit Deshmukh, John Devar, Satish Dharap, I. Di Carlo, F. Di Maggio, F. Di Marco, Davide Di Mauro, S. Di Saverio, R. Diab, A. Diamantis, Aida Diaz, Josefina Dib Hasan, T. Dilevska, N. Dimitriou, A. Dimova, S. Dindyal, Burak Dinçer, R. Donchev, Natalia Dowgiałło-gornowicz, M. Drogouti, D. Dugar, A. Duro, D. Duttaroy, E. Dyer, S. Däster, R. Díaz Pedrero, Joel Kumar Earjala, S. Efetov, S. Egreara, O. Ekwunife, Christopher Ekwunife, M. El Boghdady, Mohamed Amine El Ghali, E. El Helou, Hamida El Magrahi, Moahmed El-Kassas, A. Elsharkawy, P. Elbe, P. Elemile, Mahmoud M. Elfiky, Hamed Elgendy, F. Elhajdawe, Saifaleslam Elsahli, A. Elsayed, M. Elsayed, R. Elsheikh, I. Eltilib, A. Emran · 发表于：Lancet Global Health · 年份：2026 · DOI：10.1016/s2214-109x(25)00476-0 · 被引用次数：4 · 研究领域：Medicine
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 [...