Global variation in anastomosis and end colostomy formation following left�sided colorectal resection. Issue 3 (28th February 2019)

• Record Type: Journal Article
• Other Names: investigator.; Glasbey James C investigator.; Adisa Adewale O investigator.; Costasâ€�Chavarri Ainhoa investigator.; Qureshi Ahmad U investigator.; Allenâ€�Ingabire Jean C investigator.; Salem Hosni Khairy investigator.; Kojo Anyomih Theophilus Teddy investigator.; Tabiri Stephen investigator.; Nepogodiev Dmitri investigator.; Lilford Richard J investigator.; Harrison Ewen M investigator.; Pinkney Thomas D investigator.; Smart Neil investigator.; Bhangu Aneel investigator.; investigator.; Verjee Azmina investigator.; Runigamugabo Emmy investigator.; investigator.; Glasbey James investigator.; Bhangu Aneel investigator.; investigator.; Ademuyiwa Adesoji O investigator.; Adisa Adewale O investigator.; Aguilera Maria Lorena investigator.; Altamini Afnan investigator.; Alexander Philip investigator.; Alâ€�Saqqa Sara W investigator.; Bordaâ€�Luque Giuliano investigator.; Cornick Jen investigator.; Costasâ€�Chavarri Ainhoa investigator.; Drake Thomas M investigator.; Fergusson Stuart J investigator.; Fitzgerald J Edward investigator.; Glasbey James investigator.; Ingabire J.C Allen investigator.; Ismaïl Lawani investigator.; Jaffry Zahra investigator.; Salem Hosni Khairy investigator.; Khatri Chetan investigator.; Kirby Andrew investigator.; Kojo Anyomih Theophilus Teddy investigator.; Lapitan Marie Carmela investigator.; Lilford Richard investigator.; Mihaljevic Andre L investigator.; Mohan Midhun investigator.; Morton Dion investigator.; Mutabazi Alphonse Zeta investigator.; Nepogodiev Dmitri investigator.; Ntirenganya Faustin investigator.; Ots Riinu investigator.; Pata Francesco investigator.; Pinkney Thomas investigator.; PoÅ¡kus Tomas investigator.; Qureshi Ahmad Uzair investigator.; la Medina Antonio Ramosâ€�De investigator.; Rayne Sarah investigator.; Recinos Gustavo investigator.; Søreide Kjetil investigator.; Shaw Catherine A investigator.; Shu Sebastian investigator.; Spence Richard investigator.; Smart Neil investigator.; Tabiri Stephen investigator.; Lilford Richard investigator.; Morton Dion investigator.; Harrison Ewen M investigator.; Bhangu Aneel investigator.; investigator.; Khatri Chetan investigator.; Gobin Neel investigator.; Freitas Ana Vega investigator.; Hall Nigel investigator.; Kim Sungâ€�Hee investigator.; Negida Ahmed investigator.; Khairy Hosni investigator.; Jaffry Zahra investigator.; Chapman Stephen J investigator.; Arnaud Alexis P investigator.; Tabiri Stephen investigator.; Recinos Gustavo investigator.; Manipal Cutting Edge investigator.; Mohan Midhun investigator.; Amandito Radhian investigator.; Shawki Marwan investigator.; Hanrahan Michael investigator.; Pata Francesco investigator.; Zilinskas Justas investigator.; Roslani April Camilla investigator.; Goh Cheng Chun investigator.; Ademuyiwa Adesoji O investigator.; Irwin Gareth investigator.; Shu Sebastian investigator.; Luque Laura investigator.; Shiwani Hunain investigator.; Altamimi Afnan investigator.; Alsaggaf Mohammed Ubaid investigator.; Fergusson Stuart J investigator.; Spence Richard investigator.; 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Roi Dylan investigator.; Ismaïl Lawani investigator.; Kalles Vasileios investigator.; Pata Francesco investigator.; Nita Gabriela Elisa investigator.; Coccolini Federico investigator.; Ansaloni Luca investigator.; Pugliesi Thays Brunelli investigator.; Pardo Gabriel investigator.; Blanco Ruth investigator.; Escobar Eugenio Grasset investigator.;
• Is Part Of: BJS open. Volume 3:Issue 3(2019)
• Page Start: 403
• Page End: 414
• Publication Date: 2019-02-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.50138
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract : Background: End colostomy rates following colorectal resection vary across institutions in highâ€�income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after leftâ€�sided colorectal resection. Methods: This study comprised an analysis of GlobalSurgâ€�1 and â€�2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency leftâ€�sided colorectal resection within discrete 2â€�week windows. Countries were grouped into highâ€�, middleâ€� and lowâ€�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 leftâ€�sided colorectal resection were included: 113 (6·9 per cent) from lowâ€�HDI, 254 (15·5 per cent) from middleâ€�HDI and 1268 (77·6 per cent) from highâ€�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 lowâ€� compared with middleâ€� and highâ€�HDI settings. The association with colostomy use in lowâ€�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 leftâ€�sided colorectal resection based on income, which went beyond case mix alone. Abstract : This secondary analysis of an international prospective multicentre observational study demonstrates significant variation in the proportion of patients receiving an end stoma after leftâ€�sided colorectal resection between highâ€� and lowâ€"middleâ€�income countries; this cannot be accounted for by case mix alone. This could relate to unmeasured patient risk characteristics, but may also reflect delayed access to surgical care, lack of equipment for anastomosis formation, or differences in subspecialist colorectal training. Wide variation in stoma rates