TY - JOUR
T1 - Global variation in anastomosis and end colostomy formation following left-sided colorectal resection
AU - GlobalSurg Collaborative
AU - Adisa, Adewale O.
AU - Costas-Chavarri, Ainhoa
AU - Allen-Ingabire, Jean C.
AU - Lilford, Richard J.
AU - Harrison, Ewen M.
AU - Pinkney, Thomas D.
AU - Verjee, Azmina
AU - Runigamugabo, Emmy
AU - Altamini, Afnan
AU - Borda-Luque, Giuliano
AU - Cornick, Jen
AU - Fitzgerald, J. Edward
AU - Kirby, Andrew
AU - Mihaljevic, Andre L.
AU - Morton, Dion
AU - Ntirenganya, Faustin
AU - Ots, Riinu
AU - Shaw, Catherine A.
AU - Khatri, Chetan
AU - Gobin, Neel
AU - De Freitas, Ana Vega Carreiro
AU - Hall, Nigel
AU - Kim, Sung Hee
AU - Negida, Ahmed
AU - Jaffry, Zahra
AU - Chapman, Stephen J.
AU - Arnaud, Alexis P.
AU - Tabiri, Stephen
AU - Recinos, Gustavo
AU - Manipal, Cutting Edge
AU - Mohan, Midhun
AU - Amandito, Radhian
AU - Shawki, Marwan
AU - Hanrahan, Michael
AU - Zilinskas, Justas
AU - Roslani, April Camilla
AU - Goh, Cheng Chun
AU - Ademuyiwa, Adesoji O.
AU - Irwin, Gareth
AU - Shu, Sebastian
AU - Luque, Laura
AU - Shiwani, Hunain
AU - Altamimi, Afnan
AU - Alsaggaf, Mohammed Ubaid
AU - Spence, Richard
AU - Rayne, Sarah
AU - Jeyakumar, Jenifa
AU - Adu-Aryee, Niiarmah
AU - Bediako-Bowan, Antoinette
AU - Dedey, Florence
N1 - Publisher Copyright:
© 2019 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.
PY - 2019/6
Y1 - 2019/6
N2 - Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 percent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.
AB - Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 percent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.
UR - https://www.scopus.com/pages/publications/85078321341
U2 - 10.1002/bjs5.50138
DO - 10.1002/bjs5.50138
M3 - Article
C2 - 31891112
AN - SCOPUS:85078321341
SN - 0007-1323
VL - 3
SP - 403
EP - 414
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 3
ER -
SDG 3 Good Health and Well-being