TY - JOUR
T1 - Laparoscopy in management of appendicitis in high-, middle-, and low-income countries
T2 - a multicenter, prospective, cohort study
AU - GlobalSurg Collaborative
AU - Asian Medical Students’ Association (AMSA)
AU - Association of Surgeons in Training (ASiT)
AU - College of Surgeons of East, Central & Southern Africa (COSECSA)
AU - Cutting Edge Manipal, Egyptian Medical Student Research Association (EMRA)
AU - International Collaboration For Essential Surgery (ICES)
AU - International Federation of Medical Student Associations (IFMSA)
AU - Lifebox Foundation, School of Surgery, Student Audit and Research in Surgery (STARSurg)
AU - The Electives Network, United Kingdom National Research Collaborative, World Korean Medical Students Association (WKMSA)
AU - World Society of Emergency Surgery (WSES)
AU - World Surgical Association (WSA)
AU - Bowley, Douglas
AU - Gokani, Vimal
AU - Henry, Jaymie Ang
AU - Kong, Chia
AU - Lavy, Chris
AU - Lim, Jane
AU - Luque, Laura
AU - Maruthappu, Mahiben
AU - Mogan, Praveen
AU - Nepogodiev, Dmitri
AU - Sayyed, Raza
AU - Shalhoub, Joseph
AU - Vohra, Ravi
AU - Drake, Thomas M.
AU - Camilleri-Brennan, Julian
AU - Tabiri, Stephen
AU - Fergusson, Stuart J.
AU - Spence, Richard
AU - Fitzgerald, J. Edward F.
AU - Bhangu, Aneel
AU - Harrison, Ewen M.
AU - Ademuyiwa, Adesoji O.
AU - Fergusson, Stuart
AU - Glasbey, James C.
AU - Khatri, Chetan
AU - Mohan, Midhun
AU - Søreide, Kjetil
AU - Fermani, Claudio
AU - Balmaceda, Ruben
AU - Modolo, Maria Marta
AU - Macdermid, Ewan
AU - Gobin, Neel
AU - Chenn, Roxanne
AU - Yong, Cheryl Ou
AU - Edye, Michael
AU - Jarmin, Martin
AU - D’Amours, Scott K.
AU - Iyer, Dushyant
AU - Youssef, Daniel
AU - Phillips, Nicholas
AU - Brown, Jason
AU - George, Robert
AU - Koh, Cherry
AU - Warren, Oliver
AU - Hanley, Isaac
AU - Dickfos, Marilla
AU - Nawara, Clemens
AU - Öfner, Dietmar
AU - Primavesi, Florian
AU - Aljohani, Emad
N1 - Publisher Copyright:
© 2018, The Author(s).
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. Methods: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. Results: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33–4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76–2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42–0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14–0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11–0.44) and SSI (OR 0.21 95% CI 0.09–0.45). Conclusion: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. Trial registration: NCT02179112.
AB - Background: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. Methods: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. Results: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33–4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76–2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42–0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14–0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11–0.44) and SSI (OR 0.21 95% CI 0.09–0.45). Conclusion: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. Trial registration: NCT02179112.
KW - Appendectomy
KW - Appendicitis
KW - Global surgery
KW - Laparoscopic
KW - Operative standards
KW - Postoperative care
KW - Postoperative complications
KW - Surgical site infection
UR - https://www.scopus.com/pages/publications/85045044788
U2 - 10.1007/s00464-018-6064-9
DO - 10.1007/s00464-018-6064-9
M3 - Article
C2 - 29623470
AN - SCOPUS:85045044788
SN - 0930-2794
VL - 32
SP - 3450
EP - 3466
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
IS - 8
ER -