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 language | English (US) |
---|---|
Pages (from-to) | 3179-3188 |
Number of pages | 10 |
Journal | World Journal of Surgery |
Volume | 42 |
Issue number | 10 |
DOIs | |
State | Published - Oct 1 2018 |
Bibliographical note
Publisher Copyright:© 2018, The Author(s).
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In: World Journal of Surgery, Vol. 42, No. 10, 01.10.2018, p. 3179-3188.
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TY - JOUR
T1 - Management and Outcomes Following Surgery for Gastrointestinal Typhoid
T2 - An International, Prospective, Multicentre Cohort Study
AU - Globalsurg Collaborative, Collaborative
AU - Drake, Thomas M.
AU - Glasbey, James
AU - Fitzgerald, J. Edward
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AU - Fitzgerald, J. Edward
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AU - Kinnera, S. V.
AU - Reddy, Yella
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AU - Kumar, Sunil
AU - Mittal, Abhishek
AU - Nadkarni, Shravan
AU - Lakshmi, Harish Neelamraju
AU - Malik, Puneet
AU - Limaye, Neel
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AU - Jain, Pratik
AU - Khajanchi, Monty
AU - Satoskar, Savni
AU - Satoskar, Rajeev
AU - Mahamood, Abid Bin
AU - Coomber, Ross
AU - Johnson, Kenneth
AU - Nowers, Jennifer
AU - Mohammad, Aminu
AU - Anyanwu, Lofty John
AU - Sheshe, Abdulrahman
AU - Adesina, Alaba
AU - Faturoti, Olubukola
AU - Taiwo, Ogechukwu
AU - Ibrahim, Muhammad Habib
AU - Nasir, Abdulrasheed A.
AU - Suleiman, Siyaka Itopa
AU - Adeniyi, Adewale
AU - Adesanya, Opeoluwa
AU - Adebanjo, Ademola
AU - Williams, Omolara
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AU - Ogunyemi, Ayokunle
AU - Oludara, Mobolaji
AU - Oshodi, Olabode
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AU - Lawal, Abdul Razzaq Oluwagbemiga
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AU - Ackom, Eric
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AU - Atkins, Ebenezer Takyi
AU - Coompson, Christian Lari
AU - Yusufali, Taha
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AU - Parker, Robert
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AU - Chai, Feng Yih
AU - Asilah, Siti Mohd Desa
AU - Syibrah, Khuzaimah Zahid
AU - Chin, Pui Xin
AU - Salleh, Afizah
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AU - Roslani, April Camilla
AU - Chong, Hoong Yin
AU - Aziz, Nora Abdul
AU - Poh, Keat Seong
AU - Chai, Chu Ann
AU - Kumar, Sandip
AU - Taher, Mustafa Mohammed
AU - Kosai, Nik Ritza
AU - Aziz, Dayang Nita Abdul
AU - Rajan, Reynu
AU - Julaihi, Rokayah
AU - Jethwani, Durvesh Lacthman
AU - Yahaya, Muhammad Taqiyuddin
AU - Abdullah, Nik Azim Nik
AU - Mathew, Susan Wndy
AU - Chung, Kuet Jun
AU - Nirumal, Milaksh Kumar
AU - Goh Ern Tze, R.
AU - Ali, Syed Abdul Wahhab Eusoffee Wan
AU - Gan, Yiing Yee
AU - Ting, Jesse Ron Swire
AU - Sii, Samuel S.Y.
AU - Koay, Kean Leong
AU - Tan, Yi Koon
AU - Cheah, Alvin Ee Zhiun
AU - Wong, Chui Yee
AU - Mat, Tuan Nur’Azmah Tuan
AU - Chow, Crystal Yern Nee
AU - Har, Prisca A.L.
AU - Der, Yishan
AU - Tew, Yong Yong
AU - Henry, Fitjerald
AU - Low, Xinwei
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AU - Heng, Hian Ee
AU - Kong, Shu Ning
AU - Gan, Cheewei
AU - Mok, Yi Ting
AU - Tan, Yee Wen
AU - Palayan, Kandasami
AU - Tata, Mahadevan Deva
AU - Cheong, Yih Jeng
AU - Gunaseelan, Kuhaendran
AU - Nasir, Wan Nurul ‘Ain Wan Mohd
AU - Yoganathan, Pigeneswaren
AU - Lee, Eu Xian
AU - Saw, Jian Er
AU - Yeang, Li Jing
AU - Koh, Pei Ying
AU - Lim, Shyang Yee
AU - Teo, Shuang Yi
AU - Ajao, Akinlabi
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AU - Lawal, Taiwo
AU - Abdurrazzaaq, Abdussemiu
AU - Alada, Muslimat
AU - Nasir, Abdulrasheed
AU - Adeniran, James
AU - Habeeb, Olufemi
AU - Popoola, Ademola
AU - Adeyeye, Ademola
AU - Adebanjo, Ademola
AU - Adesanya, Opeoluwa
AU - Adeniyi, Adewale
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AU - Bello, Bashir
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AU - Olajide, Thomas Olagboyega
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AU - Alakaloko, Felix
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AU - Kache, Stephen
AU - Ajah, Jonathan
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AU - Baba, Suleiman
AU - Aliyu, Mohammad
AU - Aliyu, Shamsudeen
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AU - Aliyu, Halima
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AU - Ogunsua, Oluseyi
AU - Anyanwu, Lofty John
AU - Sheshe, Abdurrahaman
AU - Mohammad, Aminu
AU - Olori, Samson
AU - Mshelbwala, Philip
AU - Odeyemi, Babatunde
AU - Samson, Garba
AU - Timothy, Oyediran Kehinde
AU - Samuel, Sani Ali
AU - Ajiboye, Anthony
AU - Adeyeye, Ademola
AU - Amole, Isaac
AU - Abiola, Olajide
AU - Olaolorun, Akin
AU - Nadeem, Najwa
AU - Saqlain, Muhammad
AU - Abbasy, Jibran
AU - Alvi, Abdul Rehman
AU - Gala, Tanzeela
AU - Shahzad, Noman
AU - Bhopal, Kamran Faisal
AU - Iftikhar, Zainab
AU - Butt, Muhammad Talha
AU - Razi, Syed Asaat Ul
AU - Ahmed, Asdaq
AU - Niazi, Ali Khan
AU - Raza, Ibrahim
AU - Baluch, Fatima
AU - Raza, Ahmed
AU - Bani-Sadar, Ahmad
AU - Qureshi, Ahmad Uzair
AU - Adil, Muhammad
AU - Raza, Awais
AU - Javaid, Mahnoor
AU - Waqar, Muhammad
AU - Khan, Maryam Ali
AU - Arshad, Mohammad Mohsin
AU - Amjad, Mohammadasim
AU - Allen Ingabire, J. C.
AU - Mutabazi, Alphonse Zeta
AU - Uzabumwana, Norbert
AU - Duhoranenayo, Dieudonne
AU - Clegg-Lamptey, Joe Nat
AU - Imoro, Osman
AU - Abem, Owusu Emmanuel
AU - Wondoh, Paul
AU - Sale, Danjuma
AU - Abdullahi, Lawal
AU - Osagie, Olabisi
AU - Faboya, Omolara
AU - Fatuga, Adedeji
AU - Taiwo, Agboola
AU - Nwabuoku, Emeka
AU - Khan, Zain Ali
AU - Rickard, Jennifer
AU - Tan, Choy Ling
AU - Siaw, Jia Yng
AU - Yam, Sir Young
AU - Wilson, Ling
AU - Aziz, Mohamed Rezal Abdul
N1 - Publisher Copyright: © 2018, The Author(s).
PY - 2018/10/1
Y1 - 2018/10/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85046421984&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046421984&partnerID=8YFLogxK
U2 - 10.1007/s00268-018-4624-8
DO - 10.1007/s00268-018-4624-8
M3 - Article
C2 - 29725797
AN - SCOPUS:85046421984
SN - 0364-2313
VL - 42
SP - 3179
EP - 3188
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 10
ER -