Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection Academic Article uri icon

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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 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.

authors

  • Glasbey, James C
  • Adisa, Adewale O
  • Costas‐Chavarri, Ainhoa
  • Qureshi, Ahmad U
  • Allen‐Ingabire, Jean C
  • Salem, Hosni Khairy
  • Kojo, Anyomih Theophilus Teddy
  • Tabiri, Stephen
  • Nepogodiev, Dmitri
  • Lilford, Richard J
  • Harrison, Ewen M
  • Pinkney, Thomas D
  • Smart, Neil
  • Bhangu, Aneel
  • Verjee, Azmina
  • Runigamugabo, Emmy
  • Glasbey, James
  • Bhangu, Aneel
  • Ademuyiwa, Adesoji O
  • Adisa, Adewale O
  • Aguilera, Maria Lorena
  • Altamini, Afnan
  • Alexander, Philip
  • Al‐Saqqa, Sara W
  • Borda‐Luque, Giuliano
  • Cornick, Jen
  • Costas‐Chavarri, Ainhoa
  • Drake, Thomas M
  • Fergusson, Stuart J
  • Fitzgerald, J Edward
  • Glasbey, James
  • Ingabire, JC Allen
  • Ismaïl, Lawani
  • Jaffry, Zahra
  • Salem, Hosni Khairy
  • Khatri, Chetan
  • Kirby, Andrew
  • Kojo, Anyomih Theophilus Teddy
  • Lapitan, Marie Carmela
  • Lilford, Richard
  • Mihaljevic, Andre L
  • Mohan, Midhun
  • Morton, Dion
  • Mutabazi, Alphonse Zeta
  • Nepogodiev, Dmitri
  • Ntirenganya, Faustin
  • Ots, Riinu
  • Pata, Francesco
  • Pinkney, Thomas
  • Poškus, Tomas
  • Qureshi, Ahmad Uzair
  • Medina, Antonio Ramos‐De
  • Rayne, Sarah
  • Recinos, Gustavo
  • Søreide, Kjetil
  • Shaw, Catherine A
  • Shu, Sebastian
  • Spence, Richard
  • Smart, Neil
  • Tabiri, Stephen
  • Lilford, Richard
  • Morton, Dion
  • Harrison, Ewen M
  • Bhangu, Aneel
  • Khatri, Chetan
  • Gobin, Neel
  • Freitas, Ana Vega
  • Hall, Nigel
  • Kim, Sung‐Hee
  • Negida, Ahmed
  • Khairy, Hosni
  • Jaffry, Zahra
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  • Shawki, Marwan
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  • Hanrahan, Michael
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  • Gilbert, Richard
  • Clifford, Caroline
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  • Driscoll, Aoife
  • Paul, Stassen
  • Lee, Chris
  • Bowe, Ross
  • Hutch, William
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  • O'neill, Maeve
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  • Mohammed, Ahmed Rabeih
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  • Salem, Mohammed Mousa
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  • Soliman, Noha Abdullah
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  • Alaael‐Dein, Shahinaz
  • Elhusseiny, Ahmed Abd Elmoen
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  • Elshaar, Mohammed
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  • Sabe, Ahmad
  • Ahmed, Ataa
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  • Soliman, Ahmed
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  • Emadeldin, Hossam
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  • Elnagar, Ahmedglal
  • Ahmed, Saraibrahim
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  • Saleh, Amr Ahmed
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  • Bakry, Hesham Mohammed
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  • Roi, Dylan
  • Ismaïl, Lawani
  • Kalles, Vasileios
  • Pata, Francesco
  • Nita, Gabriela Elisa
  • Coccolini, Federico
  • Ansaloni, Luca
  • Pugliesi, Thays Brunelli
  • Pardo, Gabriel
  • Blanco, Ruth
  • Escobar, Eugenio Grasset

publication date

  • June 2019