| Contributors: |
A, Bhangu; C Glasbey (UK), Global variation in anastomosis and end colostomy formation following left-sided colorectal resection GlobalSurg Collaborative Appendix S1 Collaborators Authors (all the following are PubMed citable): Writing group: Jame; O Adisa (Nigeria), Adewale; Costas-Chavarri (Rwanda), Ainhoa; U Qureshi (Pakistan), Ahmad; C Allen-Ingabire (Rwanda), Jean; Khairy Salem (Egypt), Hosni; Theophilus Teddy Kojo (Ghana), Anyomih; Tabiri (Ghana), Stephen; Nepogodiev (UK), Dmitri; J Lilford (UK), Richard; M Harrison (UK), Ewen; D Pinkney (UK), Thoma; Smart (UK), Neil; Bhangu (UK, Aneel; denotes joint first author Patient representatives: Azmina Verjee (UK), study guarantor).; Runigamugabo (Rwanda) Statistical analysis: James Glasbey, Emmy; O Ademuyiwa, Aneel Bhangu Protocol development and project steering: Adesoji; O Adisa, Adewale; Lorena Aguilera, Maria; Altamini, Afnan; Alexander, Philip; W Al-Saqqa, Sara; Borda-Luque, Giuliano; Cornick, Jen; Costas-Chavarri, Ainhoa; M Drake, Thoma; J Fergusson, Stuart; Edward Fitzgerald, J; Glasbey, Jame; C Allen Ingabire, J.; Ismaïl, Lawani; Jaffry, Zahra; Khairy Salem, Hosni; Khatri, Chetan; Kirby, Andrew; Theophilus Teddy Kojo, Anyomih; Carmela Lapitan, Marie; Lilford, Richard; L Mihaljevic, Andre; Mohan, Midhun; Morton, Dion; Zeta Mutabazi, Alphonse; Nepogodiev, Dmitri; Ntirenganya, Faustin; Ots, Riinu; Pata, Francesco; Pinkney, Thoma; Poškus, Toma; Uzair Qureshi, Ahmad; Ramos-De la Medina, Antonio; Rayne, Sarah; Recinos, Gustavo; Søreide, Kjetil; A Shaw, Catherine; Shu, Sebastian; Spence, Richard; Smart, Neil; Tabiri, Stephen; M Harrison, Ewen; Bhangu National leads (GlobalSurg-1) Lead coordinator, Aneel; Neel Gobin, Australia; Ana Vega Freitas, Brazil; Nigel Hall, Canada; amp; China; Sung-Hee Kim, Hong Kong; Egypt; Negida, Ahmed; Khairy, Hosni; England; J Chapman, Stephen; Alexis P Arnaud, France; Stephen Tabiri, Ghana; Gustavo Recinos, Guatemala; India; Edge Manipal, Cutting; Radhian Amandito, Indonesia; Marwan Shawki, Iraq; Michael Hanrahan, Ireland; Francesco Pata, Italy; Justas Zilinskas, Lithuania; Malaysia; Camilla Roslani, April; Chun Goh, Cheng; Adesoji O Ademuyiwa, Nigeria; Gareth Irwin, Northern Ireland; Peru; Luque, Laura; Arabia, Saudi; Shiwani, Hunain; Altamimi, Afnan; Ubaid Alsaggaf, Mohammed; Stuart J Fergusson, Scotland |
| Description: |
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. |