| Contributors: |
M Drake, Thoma; Camilleri-Brennan, Julian; Tabiri, Stephen; J Fergusson, Stuart; Spence, Richard; F Fitzgerald, J Edward; Bhangu, Aneel; M Harrison, Ewen; O Ademuyiwa, Adesoji; Fergusson, Stuart; C Glasbey, Jame; Khatri, Chetan; Mohan, Midhun; Nepogodiev, Dmitri; Søreide, Kjetil; Gobin, Neel; Vega Freitas, Ana; Hall, Nigel; Kim, Sung-Hee; Negida, Ahmed; Jaffry, Zahra; J Chapman, Stephen; P Arnaud, Alexi; Recinos, Gustavo; Edge Manipal, Cutting; Amandito, Radhian; Shawki, Marwan; Hanrahan, Michael; Pata, Francesco; Zilinskas, Justa; Camilla Roslani, April; Chun Goh, Cheng; Irwin, Gareth; Shu, Sebastian; Luque, Laura; Shiwani, Hunain; Altamimi, Afnan; Ubaid Alsaggaf, Mohammed; Rayne, Sarah; Jeyakumar, Jenifa; Cengiz, Yucel; A Raptis, Dmitri; Fermani, Claudio; Balmaceda, Ruben; Marta Modolo, Maria; Macdermid, Ewan; Chenn, Roxanne; Ou Yong, Cheryl; Edye, Michael; Jarmin, Martin; K D'amours, Scott; Iyer, Dushyant; Youssef, Daniel; Phillips, Nichola; Brown, Jason; George, Robert; Koh, Cherry; Warren, Oliver; Hanley, Isaac; Dickfos, Marilla; Nawara, Clemen; Öfner, Dietmar; Primavesi, Florian; Rahman Mitul, Ashrarur; Mahmud, Khalid; Hussain, Margub; Hakim, Hafiz; Kumar, Tapan; Oosterkamp, Antje; A Assouto, Pamphile; Lawani, Ismail; Imorou Souaibou, Yacoubou; Kyaw Tun, Aung; Leung Chong, Chean; H Devadasar, Giridhar; Rashid Minhas Qadir, Muhammad; Phyo Aung, Kyaw; Shi Yeo, Lee; Dina Palomino Castillo, Vanessa; Moron Munhoz, Monique; Moreira, Gisele; Carlos Barros De Castro Segundo, Luiz; Anderson Khouri Ferreira, Salim; Cassa Careta, Maíra; Binna Kim, Stella; Venancio De Sousa, Alexandre; Daltri Lazzarini Cury, Alyne; Peixoto Soares Miguel, Gustavo; Vega Carreiro De Freitas, Ana; Pereira Silvestre, Barbara; Guasti Pinto Vianna, Julia; Oliveira Felipe, Carolina; Alberto Valente Laufer, Lui; Altoe, Fernanda; Ayres Da Silva, Luana; Luiza Pimenta, Marina; Fernandes Giuriato, Thiago; Alves Bezerra Morais, Paulo; Souza Luiz, Jessica; Araujo, Rafael |
| Description: |
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. |