Global variation in anastomosis and end colostomy formation following left-sided colorectal resection.
Title | Global variation in anastomosis and end colostomy formation following left-sided colorectal resection. |
Publication Type | Journal Article |
Year of Publication | 2019 |
Corporate Authors | GlobalSurg Collaborative |
Journal | BJS Open |
Volume | 3 |
Issue | 3 |
Pagination | 403-414 |
Date Published | 2019 Jun |
ISSN | 2474-9842 |
Keywords | Adult, Aged, Aged, 80 and over, Anastomosis, Surgical, Colorectal Neoplasms, Colostomy, Developed Countries, Developing Countries, Elective Surgical Procedures, Emergencies, Female, Global Health, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Prospective Studies |
Abstract | 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 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; < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; < 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; = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; < 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. |
DOI | 10.1002/bjs5.50138 |
Alternate Journal | BJS Open |
PubMed ID | 31891112 |
PubMed Central ID | PMC6921967 |
Grant List | / WT_ / Wellcome Trust / United Kingdom MR/S001751/1 / MRC_ / Medical Research Council / United Kingdom |