Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study

GlobalSurg Collaborative

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)3450-3466
Number of pages17
JournalSurgical Endoscopy and Other Interventional Techniques
Volume32
Issue number8
DOIs
Publication statusPublished - 1 Aug 2018

Fingerprint

Appendicitis
Human Development
Laparoscopy
Cohort Studies
Prospective Studies
Appendectomy
Surgical Wound Infection
Emergencies
Social Adjustment
Propensity Score
Diagnosis-Related Groups
Research Design

Keywords

  • Appendectomy
  • Appendicitis
  • Global surgery
  • Laparoscopic
  • Operative standards
  • Postoperative care
  • Postoperative complications
  • Surgical site infection

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries : a multicenter, prospective, cohort study. / GlobalSurg Collaborative.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 32, No. 8, 01.08.2018, p. 3450-3466.

Research output: Contribution to journalArticle

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title = "Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study",
abstract = "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.",
keywords = "Appendectomy, Appendicitis, Global surgery, Laparoscopic, Operative standards, Postoperative care, Postoperative complications, Surgical site infection",
author = "{GlobalSurg Collaborative} and Drake, {Thomas M.} and Julian Camilleri-Brennan and Stephen Tabiri and Fergusson, {Stuart J.} and Richard Spence and Fitzgerald, {J. Edward F.} and Aneel Bhangu and Harrison, {Ewen M.} and Ademuyiwa, {Adesoji O.} and Stuart Fergusson and Glasbey, {James C.} and Chetan Khatri and Midhun Mohan and Dmitri Nepogodiev and Kjetil S{\o}reide and Neel Gobin and Freitas, {Ana Vega} and Nigel Hall and Kim, {Sung Hee} and Ahmed Negida and Zahra Jaffry and Chapman, {Stephen J.} and Arnaud, {Alexis P.} and Gustavo Recinos and Manipal, {Cutting Edge} and Radhian Amandito and Marwan Shawki and Michael Hanrahan and Francesco Pata and Justas Zilinskas and Roslani, {April Camilla} and Goh, {Cheng Chun} and Gareth Irwin and Sebastian Shu and Laura Luque and Hunain Shiwani and Afnan Altamimi and Alsaggaf, {Mohammed Ubaid} and Sarah Rayne and Jenifa Jeyakumar and Yucel Cengiz and Raptis, {Dmitri A.} and Claudio Fermani and Ruben Balmaceda and Modolo, {Maria Marta} and Ewan Macdermid and Roxanne Chenn and Yong, {Cheryl Ou} and Michael Edye and {Nik Mahmood}, {Nik Ritza Kosai}",
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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 - 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 - Nepogodiev, Dmitri

AU - Søreide, Kjetil

AU - Gobin, Neel

AU - Freitas, Ana Vega

AU - Hall, Nigel

AU - Kim, Sung Hee

AU - Negida, Ahmed

AU - Jaffry, Zahra

AU - Chapman, Stephen J.

AU - Arnaud, Alexis P.

AU - Recinos, Gustavo

AU - Manipal, Cutting Edge

AU - Amandito, Radhian

AU - Shawki, Marwan

AU - Hanrahan, Michael

AU - Pata, Francesco

AU - Zilinskas, Justas

AU - Roslani, April Camilla

AU - Goh, Cheng Chun

AU - Irwin, Gareth

AU - Shu, Sebastian

AU - Luque, Laura

AU - Shiwani, Hunain

AU - Altamimi, Afnan

AU - Alsaggaf, Mohammed Ubaid

AU - Rayne, Sarah

AU - Jeyakumar, Jenifa

AU - Cengiz, Yucel

AU - Raptis, Dmitri A.

AU - Fermani, Claudio

AU - Balmaceda, Ruben

AU - Modolo, Maria Marta

AU - Macdermid, Ewan

AU - Chenn, Roxanne

AU - Yong, Cheryl Ou

AU - Edye, Michael

AU - Nik Mahmood, Nik Ritza Kosai

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

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