Management and Outcomes Following Surgery for Gastrointestinal Typhoid: An International, Prospective, Multicentre Cohort Study

Collaborative Globalsurg Collaborative, Thomas M. Drake, James Glasbey, J. Edward Fitzgerald, Riinu Ots, Ewen M. Harrison, Stephen Tabiri, Aneel Bhangu, Adesoji O. Ademuyiwa, Maria Lorena Aguilera, Philip Alexander, Sara W. Al-Saqqa, Giuliano Borda-Luque, Ainhoa Costas-Chavarri, Thomas M. Drake, Faustin Ntirenganya, J. Edward Fitzgerald, Stuart J. Fergusson, James Glasbey, J. C. Allen IngabireLawani Ismaïl, Hosni Khairy Salem, Anyomih Theophilus Teddy Kojo, Marie Carmela Lapitan, Richard Lilford, Andre L. Mihaljevic, Dion Morton, Alphonse Zeta Mutabazi, Dmitri Nepogodiev, Adewale O. Adisa, Riinu Ots, Francesco Pata, Thomas Pinkney, Tomas Poškus, Ahmad Uzair Qureshi, Antonio Ramos De la Medina, Sarah Rayne, Catherine A. Shaw, Sebastian Shu, Richard Spence, Neil Smart, Stephen Tabiri, Ewen M. Harrison, A. O. Ademuyiwa, S. Tabiri, Cutting Edge Manipal, M. Mohan, J. Jeyakumar, Ashrarur Rahman Mitul, Khalid Mahmud, Margub Hussain, Hafiz Hakim, Tapan Kumar, Antje Oosterkamp, Francis Abantanga, Kwaku Boakye-Yiadom, Mohammed Bukari, Frank Owusu, Joseph Awuku-Asabre, Stephen Tabiri, Lemuel Davies Bray, S. S. Prasad, Anand Kirishnan, Nidhi Gyanchandani, Bylapudi Seshu Kumar, Muthukumaran Rangarajan, Sriram Bhat, Anjana Sreedharan, S. V. Kinnera, Yella Reddy, Caranj Venugopal, Sunil Kumar, Abhishek Mittal, Shravan Nadkarni, Harish Neelamraju Lakshmi, Puneet Malik, Neel Limaye, Srinivas Pai, Pratik Jain, Monty Khajanchi, Savni Satoskar, Rajeev Satoskar, Abid Bin Mahamood, Ross Coomber, Kenneth Johnson, Jennifer Nowers, Aminu Mohammad, Lofty John Anyanwu, Abdulrahman Sheshe, Alaba Adesina, Olubukola Faturoti, Ogechukwu Taiwo, Muhammad Habib Ibrahim, Abdulrasheed A. Nasir, Siyaka Itopa Suleiman, Adewale Adeniyi, Opeoluwa Adesanya, Ademola Adebanjo, Omolara Williams, Kazeem Atobatele, Ayokunle Ogunyemi, Mobolaji Oludara, Olabode Oshodi, Roland Osuoji, Adesoji Ademuyiwa, Abdul Razzaq Oluwagbemiga Lawal, Felix Alakaloko, Olumide Elebute, Adedapo Osinowo, Christopher Bode, Abidemi Adesuyi, Adesoji Tade, Adeleke Adekoya, Collins Nwokoro, Omobolaji O. Ayandipo, Taiwo Akeem Lawal, Akinlabi E. Ajao, Samuel Sani Ali, Babatunde Odeyemi, Samson Olori, Ademola Popoola, Ademola Adeyeye, James Adeniran, Kamran Faisal Bhopal, Zainab Iftikhar, Muhammad Mohsin Furqan, Bakhtiar Nighat, Masood Jawaid, Abdul Khalique, Ahsan Zil-E-Ali, Anam Rashid, Hasnain Abbas Dharamshi, Tahira Naqvi, Ahmad Faraz, Abdul Wahid Anwar, Tahir Muhammad Yaseen, Ghina Shamim Shamsi, Ghina Shamsi, Tahir Yaseen, Wahid Anwer, Prasad Pitigala Arachchi, Wanigasekara Senanayake Mudiyanselage Kithsiri Janakantha Senanayake, Lalith Asanka Jayasooriya Jayasooriya Arachchige, Sivasuriya Sivaganesh, Dulan Irusha Samaraweera, Vimalakanthan Thanusan, Lawani Ismaïl, Stephen Tabiri, Yong Yong Tew, Adesoji O. Ademuyiwa, Tanzeela Gala, Fernande Djivoh, Lawani Ismaïl, Francis Dossou, Djifid Morel Seto, Dansou Gaspard Gbessi, Bruno Noukpozounkou, Yacoubou Imorou Souaibou, Kpèmahouton René Keke, Fred Hodonou, Ernest Yemalin Stephane Ahounou, Thierry Alihonou, Max Dénakpo, Germain Ahlonsou, Stephen Tabiri, Anyomih Theophilus Teddy Kojo, Dickson Bandoh, Francis Abantanga, Martin Kyereh, Hamza Asumah, Eric Kofi Appiah, Paul Wondoh, Adam Gyedu, Charles Dally, Kwabena Agbedinu, Michael Amoah, Abiboye Yifieyeh, Frank Owusu, Mabel Amoako-Boateng, Makafui Dayie, Richmond Hagan, Sam Debrah, Micheal Ohene-Yeboah, Joe Nat Clegg-Lampety, Victor Etwire, Jonathan Dakubo, Samuel Essoun, William Bonney, Hope Glover-Addy, Samuel Osei-Nketiah, Joachim Amoako, Niiarmah Adu-Aryee, William Appeadu-Mensah, Antoinette Bediako-Bowan, Florence Dedey, Mattew Ekow, Emmanuel Akatibo, Musah Yakubu, Hope Edem Kofi Kordorwu, Kwasi Asare-Bediako, Enoch Tackie, Kenneth Aaniana, Emmanuel Acquah, Richard Opoku-Agyeman, Anthony Avoka, Kwasi Kusi, Kwame Maison, Frank Enoch Gyamfi, Gandau Naa Barnabas, Saiba Abdul-Latif, Philip Taah Amoako, Anthony Davor, Victor Dassah, Enoch Dagoe, Prince Kwakyeafriyie, Elliot Akoto, Eric Ackom, Ekow Mensah, Ebenezer Takyi Atkins, Christian Lari Coompson, Taha Yusufali, Hussein Mohammed, Justus Lando, Robert Parker, Wairimu Ndegwa, Feng Yih Chai, Siti Mohd Desa Asilah, Khuzaimah Zahid Syibrah, Pui Xin Chin, Afizah Salleh, Nur Zulaika Riswan, April Camilla Roslani, Hoong Yin Chong, Nora Abdul Aziz, Keat Seong Poh, Chu Ann Chai, Sandip Kumar, Mustafa Mohammed Taher, Nik Ritza Kosai, Dayang Nita Abdul Aziz, Reynu Rajan, Rokayah Julaihi, Durvesh Lacthman Jethwani, Muhammad Taqiyuddin Yahaya, Nik Azim Nik Abdullah, Susan Wndy Mathew, Kuet Jun Chung, Milaksh Kumar Nirumal, R. Goh Ern Tze, Syed Abdul Wahhab Eusoffee Wan Ali, Yiing Yee Gan, Jesse Ron Swire Ting, Samuel S.Y. Sii, Kean Leong Koay, Yi Koon Tan, Alvin Ee Zhiun Cheah, Chui Yee Wong, Tuan Nur’Azmah Tuan Mat, Crystal Yern Nee Chow, Prisca A.L. Har, Yishan Der, Yong Yong Tew, Fitjerald Henry, Xinwei Low, Ya Theng Neo, Hian Ee Heng, Shu Ning Kong, Cheewei Gan, Yi Ting Mok, Yee Wen Tan, Kandasami Palayan, Mahadevan Deva Tata, Yih Jeng Cheong, Kuhaendran Gunaseelan, Wan Nurul ‘Ain Wan Mohd Nasir, Pigeneswaren Yoganathan, Eu Xian Lee, Jian Er Saw, Li Jing Yeang, Pei Ying Koh, Shyang Yee Lim, Shuang Yi Teo, Akinlabi Ajao, Omobolaji Ayandipo, Taiwo Lawal, Abdussemiu Abdurrazzaaq, Muslimat Alada, Abdulrasheed Nasir, James Adeniran, Olufemi Habeeb, Ademola Popoola, Ademola Adeyeye, Ademola Adebanjo, Opeoluwa Adesanya, Adewale Adeniyi, Henry Mendel, Bashir Bello, Umar Muktar, Adedapo Osinowo, Thomas Olagboyega Olajide, Oyindamola Oshati, George Ihediwa, Babajide Adenekan, Victor Nwinee, Felix Alakaloko, Adesoji Ademuyiwa, Olumide Elebute, Abdulrazzaq Lawal, Chris Bode, Mojolaoluwa Olugbemi, Alaba Adesina, Olubukola Faturoti, Oluwatomi Odutola, Oluwaseyi Adebola, Clement Onuoha, Ogechukwu Taiwo, Omolara Williams, Fatai Balogun, Olalekan Ajai, Mobolaji Oludara, Iloba Njokanma, Roland Osuoji, Stephen Kache, Jonathan Ajah, Jerry Makama, Ahmed Adamu, Suleiman Baba, Mohammad Aliyu, Shamsudeen Aliyu, Yahaya Ukwenya, Halima Aliyu, Tunde Sholadoye, Muhammad Daniyan, Oluseyi Ogunsua, Lofty John Anyanwu, Abdurrahaman Sheshe, Aminu Mohammad, Samson Olori, Philip Mshelbwala, Babatunde Odeyemi, Garba Samson, Oyediran Kehinde Timothy, Sani Ali Samuel, Anthony Ajiboye, Ademola Adeyeye, Isaac Amole, Olajide Abiola, Akin Olaolorun, Najwa Nadeem, Muhammad Saqlain, Jibran Abbasy, Abdul Rehman Alvi, Tanzeela Gala, Noman Shahzad, Kamran Faisal Bhopal, Zainab Iftikhar, Muhammad Talha Butt, Syed Asaat Ul Razi, Asdaq Ahmed, Ali Khan Niazi, Ibrahim Raza, Fatima Baluch, Ahmed Raza, Ahmad Bani-Sadar, Ahmad Uzair Qureshi, Muhammad Adil, Awais Raza, Mahnoor Javaid, Muhammad Waqar, Maryam Ali Khan, Mohammad Mohsin Arshad, Mohammadasim Amjad, J. C. Allen Ingabire, Alphonse Zeta Mutabazi, Norbert Uzabumwana, Dieudonne Duhoranenayo, Joe Nat Clegg-Lamptey, Osman Imoro, Owusu Emmanuel Abem, Paul Wondoh, Danjuma Sale, Lawal Abdullahi, Olabisi Osagie, Omolara Faboya, Adedeji Fatuga, Agboola Taiwo, Emeka Nwabuoku, Zain Ali Khan, Jennifer Rickard, Choy Ling Tan, Jia Yng Siaw, Sir Young Yam, Ling Wilson, Mohamed Rezal Abdul Aziz

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: Gastrointestinal perforation is the most serious complication of typhoid fever, with a high disease burden in low-income countries. Reliable, prospective, contemporary surgical outcome data are scarce in these settings. This study aimed to investigate surgical outcomes following surgery for intestinal typhoid. Methods: Two multicentre, international prospective cohort studies of consecutive patients undergoing surgery for gastrointestinal typhoid perforation were conducted. Outcomes were measured at 30 days and included mortality, surgical site infection, organ space infection and reintervention rate. Multilevel logistic regression models were used to adjust for clinically plausible explanatory variables. Effect estimates are expressed as odds ratios (ORs) alongside their corresponding 95% confidence intervals. Results: A total of 88 patients across the GlobalSurg 1 and GlobalSurg 2 studies were included, from 11 countries. Children comprised 38.6% (34/88) of included patients. Most patients (87/88) had intestinal perforation. The 30-day mortality rate was 9.1% (8/88), which was higher in children (14.7 vs. 5.6%). Surgical site infection was common, at 67.0% (59/88). Organ site infection was common, with 10.2% of patients affected. An ASA grade of III and above was a strong predictor of 30-day post-operative mortality, at the univariable level and following adjustment for explanatory variables (OR 15.82, 95% CI 1.53–163.57, p = 0.021). Conclusions: With high mortality and complication rates, outcomes from surgery for intestinal typhoid remain poor. Future studies in this area should focus on sustainable interventions which can reduce perioperative morbidity. At a policy level, improving these outcomes will require both surgical and public health system advances.

Original languageEnglish (US)
Pages (from-to)3179-3188
Number of pages10
JournalWorld Journal of Surgery
Volume42
Issue number10
DOIs
StatePublished - Oct 1 2018

Bibliographical note

Funding Information:
Organisations assisting in dissemination and/or translation (alphabetical): Asian Medical Students’ Association (AMSA), Association of Surgeons in Training (ASiT), College of Surgeons of East, Central and Southern Africa (COSECSA), Cutting Edge Manipal, Egyptian Medical Student Research Association (EMRA), International Collaboration For Essential Surgery (ICES), International Federation of Medical Student Associations (IFMSA), Italian Society of Colorectal Surgery (SICCR), Lifebox Foundation, School of Surgery, Student Audit and Research in Surgery (STARSurg), The Electives Network, United Kingdom National Research Collaborative, World Society of Emergency Surgery (WSES), World Surgical Association (WSA).

Funding Information:
Acknowledgements Funded by DFID-MRC-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 17-0799). 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:
© 2018, The Author(s).

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