Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

GlobalSurg Collaborative

Research output: Contribution to journalArticlepeer-review

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 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.

Original languageEnglish (US)
Pages (from-to)403-414
Number of pages12
JournalBritish Journal of Surgery
Volume3
Issue number3
DOIs
StatePublished - Jun 2019
Externally publishedYes

Bibliographical note

Funding Information:
This paper reports the results of two preregistered studies (ClinicalTrials.gov; NCT02179112 and NCT02662231). To minimize the possibility of unintentionally sharing information that can be used to reidentify private information, a subset of the summary data generated for this study are available in an online visualization application that can be accessed at http://ssi.globalsurg.org40. Organizations assisting in dissemination and/or translation: Asian Medical Students? Association; Association of Surgeons in Training; College of Surgeons of East, Central and Southern Africa; Cutting Edge Manipal; Egyptian Medical Student Research Association; International Collaboration for Essential Surgery; International Federation of Medical Student Associations; Italian Society of Colorectal Surgery; Lifebox Foundation; School of Surgery; Student Audit and Research in Surgery; The Electives Network; United Kingdom National Research Collaborative; World Society of Emergency Surgery; and World Surgical Association. This study was funded by Department For International Development?Medical Research Council?Wellcome Trust Joint Global Health Trial Development grant (MR/N022114/1) and a National Institute of Health Research (NIHR) Global Health Research Unit Grant (NIHR 16/136/79). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the UK Department of Health.

Funding Information:
This study was funded by Department For International Development–Medical Research Council–Wellcome Trust Joint Global Health Trial Development grant (MR/N022114/1) and a National Institute of Health Research (NIHR) Global Health Research Unit Grant (NIHR 16/136/79). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the UK Department of Health.

Publisher Copyright:
© 2019 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

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