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Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study
NIHR Unit on Global Surgery (Universities of Birmingham, Edinburgh and Warwick), University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.ORCID-id: 0000-0002-7516-9543
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
2018 (Engelska)Ingår i: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 32, nr 8, s. 3450-3466Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

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.

TRIAL REGISTRATION: NCT02179112.

Ort, förlag, år, upplaga, sidor
Springer, 2018. Vol. 32, nr 8, s. 3450-3466
Nyckelord [en]
Appendectomy, Appendicitis, Global surgery, Laparoscopic, Operative standards, Postoperative care, Postoperative complications, Surgical site infection
Nationell ämneskategori
Kirurgi
Identifikatorer
URN: urn:nbn:se:umu:diva-154582DOI: 10.1007/s00464-018-6064-9ISI: 000438285100004PubMedID: 29623470OAI: oai:DiVA.org:umu-154582DiVA, id: diva2:1272812
Tillgänglig från: 2018-12-19 Skapad: 2018-12-19 Senast uppdaterad: 2019-01-07Bibliografiskt granskad

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Sund, MalinAndersson, LindaGunnarsson, Ulf

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