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

GlobalSurg Collaborative, . and , (2018) Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study. Surgical Endoscopy, 32(8), pp. 3450-3466. (doi: 10.1007/s00464-018-6064-9) (PMID:29623470) (PMCID:PMC6061087)

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.

• Item Type: Articles
• Additional Information: Funded by a DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant (MR/N022114/1), a Wellcome Trust Biomedical Vacation Scholarships (2015), and a National Institute of Health Research (NIHR) Global Health Research Unit Grant (NIHR 17-0799). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health and Social Care.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Khan, Mr Khurram
• Authors: GlobalSurg Collaborative, ., and ,
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Surgical Endoscopy
• Publisher: Springer
• ISSN: 0930-2794
• ISSN (Online): 1432-2218
• Copyright Holders: Copyright © 2018 The Author(s)
• First Published: First published in Surgical Endoscopy 32(8):3450-3466
• Publisher Policy: Reproduced under a Creative Commons license