| Contributors: |
Adisa, A. O.; Costas-Chavarri, A.; Allen-Ingabire, J. C.; Lilford, R. J.; Harrison, E. M.; Pinkney, T. D.; Verjee, A.; Runigamugabo, E.; Altamini, A.; Borda-Luque, G.; Cornick, J.; Fitzgerald, J. E.; Kirby, A.; Mihaljevic, A. L.; Morton, D.; Ntirenganya, F.; Ots, R.; Shaw, C. A.; Khatri, C.; Gobin, N.; Freitas, A. V.; Hall, N.; Kim, S. -H.; Negida, A.; Jaffry, Z.; Chapman, S. J.; Arnaud, A. P.; Tabiri, S.; Recinos, G.; Manipal, C. E.; Mohan, M.; Amandito, R.; Shawki, M.; Hanrahan, M.; Zilinskas, J.; Roslani, A. C.; Goh, C. C.; Ademuyiwa, A. O.; Irwin, G.; Shu, S.; Luque, L.; Shiwani, H.; Altamimi, A.; Alsaggaf, M. U.; Spence, R.; Rayne, S.; Jeyakumar, J.; Raptis, D. A.; Glasbey, J. C.; Modolo, M. M.; Iyer, D.; King, S.; Arthur, T.; Nahar, S. N.; Waterman, A.; Walsh, M.; Agarwal, A.; Zani, A.; Firdouse, M.; Rouse, T.; Liu, Q.; Correa, J. C.; Salem, H. K.; Talving, P.; Worku, M.; Kalles, V.; Kumar, B.; Kumar, S.; Quek, R.; Pata, F.; Ansaloni, L.; Altibi, A.; Venskutonis, D.; Poskus, T.; Whitaker, J.; Msosa, V.; Tew, Y. Y.; Farrugia, A.; Borg, E.; Ramos-De La Medina, A.; Bentounsi, Z.; Søreide, K.; Gala, T.; Al-Slaibi, I.; Tahboub, H.; Alser, O. H.; Romani, D.; Major, P.; Mironescu, A.; Bratu, M. R.; Kourdouli, A.; Ndajiwo, A.; Altwijri, A.; Gudal, A.; Jubran, A. F.; Seisay, S.; Lieske, B.; Ortega, I.; Senanayake, K. J. |
| 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 per cent) 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. |