Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study
Articolo
Data di Pubblicazione:
2018
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.
Tipologia CRIS:
Articolo su Rivista
Keywords:
Appendectomy; Appendicitis; Global surgery; Laparoscopic; Operative standards; Postoperative care; Postoperative complications; Surgical site infection; Surgery
Elenco autori:
Drake, Thomas M.; Camilleri-Brennan, Julian; Tabiri, Stephen; Fergusson, Stuart J.; Spence, Richard; Fitzgerald, J. Edward F.; Bhangu, Aneel; Harrison, Ewen M.; Ademuyiwa, Adesoji O.; Fergusson, Stuart; Glasbey, James C.; Khatri, Chetan; Mohan, Midhun; Nepogodiev, Dmitri; Søreide, Kjetil; Gobin, Neel; Freitas, Ana Vega; Hall, Nigel; Kim, Sung-Hee; Negida, Ahmed; Jaffry, Zahra; Chapman, Stephen J.; Arnaud, Alexis P.; Recinos, Gustavo; Manipal, Cutting Edge; Amandito, Radhian; Shawki, Marwan; Hanrahan, Michael; Pata, Francesco; Zilinskas, Justas; Roslani, April Camilla; Goh, Cheng Chun; Irwin, Gareth; Shu, Sebastian; Luque, Laura; Shiwani, Hunain; Altamimi, Afnan; Alsaggaf, Mohammed Ubaid; Rayne, Sarah; Jeyakumar, Jenifa; Cengiz, Yucel; Raptis, Dmitri A.; Fermani, Claudio; Balmaceda, Ruben; Modolo, Maria Marta; Macdermid, Ewan; Chenn, Roxanne; Yong, Cheryl Ou; Edye, Michael; Jarmin, Martin; D’Amours, Scott K.; Iyer, Dushyant; Youssef, Daniel; Phillips, Nicholas; Brown, Jason; George, Robert; Koh, Cherry; Warren, Oliver; Hanley, Isaac; Dickfos, Marilla; Nawara, Clemens; Öfner, Dietmar; Primavesi, Florian; Mitul, Ashrarur Rahman; Mahmud, Khalid; Hussain, Margub; Hakim, Hafiz; Kumar, Tapan; Oosterkamp, Antje; Assouto, Pamphile A.; Lawani, Ismail; Souaibou, Yacoubou Imorou; Tun, Aung Kyaw; Chong, Chean Leung; Devadasar, Giridhar H.; Qadir, Muhammad Rashid Minhas; Aung, Kyaw Phyo; Yeo, Lee Shi; Castillo, Vanessa Dina Palomino; Munhoz, Monique Moron; Moreira, Gisele; De Castro Segundo, Luiz Carlos Barros; Ferreira, Salim Anderson Khouri; Careta, Maíra Cassa; Kim, Stella Binna; De Sousa, Alexandre Venancio; Cury, Alyne Daltri Lazzarini; Miguel, Gustavo Peixoto Soares; De Freitas, Ana Vega Carreiro; Silvestre, Barbara Pereira; Vianna, Julia Guasti Pinto; Felipe, Carolina Oliveira; Laufer, Luis Alberto Valente; Altoe, Fernanda; Da Silva, Luana Ayres; Pimenta, Marina Luiza; Giuriato, Thiago Fernandes; Morais, Paulo Alves Bezerra; Luiz, Jessica Souza; Araujo, Rafael; Menegussi, Juliana; Leal, Marisa; de Lima, Caio Vinícius Barroso; Tatagiba, Luiza Sarmento; Leal, Antônio; dos Santos, Diogo Vinicius; Fraga, Gustavo Pereira; Simoes, Romeo Lages; Stock, Simon; Nigo, Samuel; Kabba, Juana; Ngwa, Tagang Ebogo; Brown, James; King, Sebastian; Zani, Augusto; Azzie, Georges; Firdouse, Mohammed; Kushwaha, Sameer; Agarwal, Arnav; Bailey, Karen; Cameron, Brian; Livingston, Michael; Horobjowsky, Alexandre; Deckelbaum, Dan L.; Razek, Tarek; Marinkovic, Boris; Grasset, Eugenio; D’Aguzan, Nicole; Jimenez, Julio; Macchiavello, Roberto; Zhang, Zhongtao; Guo, Wei; Oh, Junyeong; Zheng, Fei; Montes, Irene; Sierra, Sebastian; Mendez, Manuela; Villegas, Maria Isabel; Arango, Maria Clara Mendoza; Mendoza, Ivan; Aristizã¡bal, Fred Alexander Naranjo; Botero, Jaime Andres Montoya; Riaza, Victor Manuel Quintero; Restrepo, Jakeline; Morales, Carlos; Cruz, Herman; Munera, Alejandro; Karlo, Robert; Domini, Edgar; Mihanovic, Jakov; Radic, Mihael; Zamarin, Kresimir; Pezelj, Nikica; Hache-Marliere, Manuel; Lemaire, Sylvia Batista; Rivas, Ruben; Khyrallh, Ahmed; Hassan, Ahamed; Shimy, Gamal; Baky Fahmy, Mohamed A.; Nabawi, Ayman; Elfil, Mohamed; Ghoneem, Mohamed; Gohar, Muhammad El-Saied Ahmad Muhammad; Asal, Mohamed; Abdelkader, Mostafa; Gomah, Mahmoud; Rashwan, Hayssam; Karkeet, Mohamed; Gomaa, Ahmed; Hasan, Amr; Elgebaly, Ahmed; Saleh, Omar; Fattah, Ahmad Abdel; Gouda, Abdullah; Elshafay, Abd Elrahman; Gharib, Abdalla; Menshawy, Ahmed; Hanafy, Mohammed; Al-Mallah, Abdullah; Abdulgawad, Mahmoud; Baheeg, Mohamad; Alhendy, Mohammed; Abdelfattah, Ibrahim; Kenibar, Abdalla; Osman, Omar; Gemeah, Mostafa; Mohammed, Ahmed; Adel, Abdalrahman; Mohammed, Abdelrahman; Sayed, Abdelrahman; Abozaid, Mohamed; Kotb, Ahmed Hafez El-Badri; Ata, Ali Amin Ahmed; Nasr, Mohammed; Alkammash, Abdelrahman; Saeed, Mohammed; Hamid, Nader Abd El; Attia, Attia Mohamed; Galeel, Ahmed Abd El; Elbanby, Eslam; El-Dien, Khalid Salah; Hantour, Usama; Alahmad
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