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

open3427siBackground: 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.openGlasbey, 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, J.C 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; Chapman, Stephen J; Arnaud, Alexis P; Tabiri, Stephen; Recinos, Gustavo; Manipal, Cutting Edge; Mohan, Midhun; Amandito, Radhian; Shawki, Marwan; Hanrahan, Michael; Pata, Francesco; Zilinskas, Justas; Roslani, April Camilla; Goh, Cheng Chun; Ademuyiwa, Adesoji O; Irwin, Gareth; Shu, Sebastian; Luque, Laura; Shiwani, Hunain; Altamimi, Afnan; Alsaggaf, Mohammed Ubaid; Fergusson, Stuart J; Spence, Richard; Rayne, Sarah; Jeyakumar, Jenifa; Cengiz, Yucel; Raptis, Dmitri A; Glasbey, James C; Modolo, Maria Marta; 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Nighat, Bakhtiar; Jawaid, Masood; Khalique, Abdul; Zil‐E‐Ali, Ahsan; Rashid, Anam; Dharamshi, Hasnain Abbas; Naqvi, Tahira; Faraz, Ahmad; Anwar, Abdul Wahid; Yaseen, Tahir Muhammad; Shamsi, Ghina Shamim; Shamsi, Ghina; Yaseen, Tahir; Anwer, Wahid; Decoud, Horacio Paredes; Aguilera, Omar; Alvarez, Ismael Isaac Zelada; Delgado, Juan Marcelo; Vega, Gustavo Miguel Machain; Lohse, Helmut Alfredo Segovia; Aguilar, Wendy Leslie Messa; Chiong, Jose Antonio Cabala; Bautista, Ana Cecilia Manchego; Huaman, Eduardo; Zegarra, Sergio; Camacho, Rony; Celis, Jose María Vergara; Pozo, Diego Alonso Romani; Hamasaki, José; Temoche, Edilberto; Herrera‐Matta, Jaime; Torres, Carla Pierina García; Barreda, Luis Miguel Alvarez; Ojeda, Ronald Renato Barrionuevo; Garaycochea, Octavio; Mollo, Melanie Castro; Delgado, Mitchelle Solange De Fã Tima Linare; Fujii, Francisco; Bautista, Ana Cecilia Manchego; Aguilar, Wendy Leslie Messa; Chiong, Jose Antonio Cabala; Durand, Susana Yrma Aranzabal; Basto, Carlos Alejandro Arroyo; Rojas, Nelson Manuel Urbina; Yip, Sebastian Bernardo Shu; Vergara, Ana Lucia Contreras; Moran, Andrea Echevarria Rosas; Luque, Giuliano Borda; Castro, Manuel Rodriguez; Jaramillo, Ramon Alvarado; Sila, George Manrique; Lopez, Crislee Elizabeth; De Leon, Mardelangel Zapata Ponze; Machaca, Massiell; Huaraya, Ronald Coasaca; Arenas, Andy; López, Crislee; Puma, Clara Milagros Herrera; Pino, Wilfredo; Hinojosa, Christian; De Leon, Melanie Zapata Ponze; Limache, Susan; Sila, George Manrrique; Rodriguez, Layza‐Alejandra Mercado; Melo, Renato; Costa‐Maia, Jose; Muralha, Nuno; Sauvat, Frederique; Dan, Ionasc; Hogea, Mircea; Eduard, Pandi; Bratu, Razvan‐Matei; Beuran, Mircea; Diaconescu, Ionut‐Bogdan; Martian, Bogdan‐Valeriu; Iordache, Florin‐Mihail; Vartic, Mihaela; Vida, Lucian Corneliu; Muntean, Liviu Iuliu; Mironescu, Aurel Sandu; Nsengimana, Vizir Jean Paul; Niragire, Alice; Ingabire, Jean De La Croix Allen; Niyirera, Eugene; Zanini, Nicola; Jovine, Elio; Landolfo, Giovanni; Alomar, Ibrahim N.; Alnuqaydan, Saleh A.; Altwigry, Abdulrahman M.; Othman, Moayad; Osman, Nohad; Alqahtani, Enas; Alzahrani, Mohammed; Alyami, Rifan; Aljohani, Emad; Alhabli, Ibrahim; Mikwar, Zaher; Almuallem, Sultan; Aljohani, Emad; Alyami, Rifan; Alzahrani, Mohammed; Nawawi, Abrar; Bakhaidar, Mohamad; Maghrabi, Ashraf A.; Alsaggaf, Mohammed; Aljiffry, Murad; Altaf, Abdulmalik; Khoja, Ahmad; Habeebullah, Alaa; Akeel, Nouf; Ghandora, Nashat; Almoflihi, Abdullah; Huwait, Abdulmalik; Al‐shammari, Abeer; Al‐Mousa, Mashael; Alghamdi, Masood; Adham, Walid; Albeladi, Bandar; Alfarsi, Muayad Ahmed; Mahdi, Atif; Al Awwad, Saad; Altamimi, Afnan; Nouh, Thamer; Hassanain, Mazen; Aldhafeeri, Salman; Sadig, Nawal; Algohary, Osama; Aledrisy, Mohannad; Gudal, Ahmad; Alrifaie, Ahmad; AlRowais, Mohammed; Althwainy, Amani; Shabkah, Alaa; Alamoudi, Uthman; Alrajraji, Mawaddah; Alghamdi, Basim; Aljohani, Saud; Daqeeq, Abdullah; Al‐Faifi, Jubran J; Jennings, Vicky;

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

none3427noBackground: 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.noneGlasbey, 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, J.C 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; Chapman, Stephen J; Arnaud, Alexis P; Tabiri, Stephen; Recinos, Gustavo; Manipal, Cutting Edge; Mohan, Midhun; Amandito, Radhian; Shawki, Marwan; Hanrahan, Michael; Pata, Francesco; Zilinskas, Justas; Roslani, April Camilla; Goh, Cheng Chun; Ademuyiwa, Adesoji O; Irwin, Gareth; Shu, Sebastian; Luque, Laura; Shiwani, Hunain; Altamimi, Afnan; Alsaggaf, Mohammed Ubaid; Fergusson, Stuart J; Spence, Richard; Rayne, Sarah; Jeyakumar, Jenifa; Cengiz, Yucel; Raptis, Dmitri A; Glasbey, James C; Modolo, Maria Marta; Iyer, Dushyant; King, Sebastian; Arthur, Tom; Nahar, Sayeda Nazmum; Waterman, Ade; Ismaïl, Lawani; Walsh, Michael; Agarwal, Arnav; Zani, Augusto; Firdouse, Mohammed; Rouse, Tyler; Liu, Qinyang; Correa, Juan Camilo; Salem, Hosni Khairy; Talving, Peep; Worku, Mengistu; Arnaud, Alexis; Tabiri, Stephen; Kalles, Vassilis; Aguilera, Maria Lorena; Recinos, Gustavo; Kumar, Basant; Kumar, Sunil; Amandito, Radhian; Quek, Roy; Pata, Francesco; Ansaloni, Luca; Altibi, Ahmed; Venskutonis, Donatas; Zilinskas, Justas; Poskus, Tomas; Whitaker, John; Msosa, Vanessa; Tew, Yong Yong; Farrugia, Alexia; Borg, Elaine; Medina, Antonio Ramos‐De; Bentounsi, Zineb; Ademuyiwa, Adesoji O; Søreide, Kjetil; Gala, Tanzeela; Al‐Slaibi, Ibrahim; Tahboub, Haya; Alser, Osaid H.; Romani, Diego; Shu, Sebestian; Major, Piotr; Mironescu, Aurel; Bratu, Matei; Kourdouli, Amar; Ndajiwo, Aliyu; Altwijri, Abdulaziz; Alsaggaf, Mohammed Ubaid; Gudal, Ahmad; Jubran, Al Faifi; Seisay, Sam; Lieske, Bettina; Rayne, Sarah; Spence, Richard; Ortega, Irene; Jeyakumar, Jenifa; Senanayake, Kithsiri J.; Abdulbagi, Omar; Cengiz, Yucel; Raptis, Dmitri; Altinel, Yuksel; Kong, Chia; Teasdale, Ella; Irwin, Gareth; Stoddart, Michael; Kabariti, Rakan; Suresh, Sukrit; Gash, Katherine; Narayanan, Ragavan; Maimbo, Mayaba; Fermani, Claudio; Balmaceda, Ruben; Modolo, Maria Marta; Macdermid, Ewan; Gobin, Neel; Chenn, Roxanne; Yong, Cheryl Ou; Edye, Michael; Jarmin, Martin; D'amours, Scott K; Iyer, Dushyant; Youssef, Daniel; Phillips, Nicholas; Brown, Jason; George, Robert; Koh, Cherry; Warren, Oliver; Hanley, Isaac; Dickfos, Marilla; Nawara, Clemens; Öfner, Dietmar; Primavesi, Florian; Mitul, Ashrarur Rahman; Mahmud, Khalid; Hussain, Margub; Hakim, Hafiz; Kumar, Tapan; Oosterkamp, Antje; Assouto, Pamphile A; Lawani, Ismail; Souaibou, Yacoubou Imorou; Tun, Aung Kyaw; Chong, Chean Leung; Devadasar, Giridhar H; Chong, Chean Leung; Qadir, Muhammad Rashid Minhas; Aung, Kyaw Phyo; Yeo, Lee Shi; Chong, Chean Leung; Castillo, Vanessa Dina Palomino; Munhoz, Monique Moron; Moreira, Gisele; De Castro Segundo, Luiz Carlos Barros; Ferreira, Salim Anderson Khouri; Careta, Maíra Cassa; Kim, Stella Binna; De Sousa, Alexandre Venancio; Cury, Alyne Daltri Lazzarini; Miguel, Gustavo Peixoto Soares; De Freitas, Ana Vega Carreiro; Guasti, Barbara Pereira Silvestre Julia; Vianna, Pinto; Felipe, Carolina Oliveira; Laufer, Luis Alberto Valente; Altoe, Fernanda; Da Silva, Luana Ayres; Pimenta, Marina Luiza; Giuriato, Thiago Fernandes; Morais, Paulo Alves Bezerra; Araujo, Jessica Souza Luiz Rafael; Menegussi, Juliana; Leal, Marisa; Lima, Caio Vinícius Barroso; Tatagiba, Luiza Sarmento; Leal, Antônio; Santos, Diogo Vinicius; Fraga, Gustavo Pereira; Simoes, Romeo Lages; Stock, Simon; Nigo, Samuel; Kabba, Juana; Ngwa, Tagang Ebogo; Brown, James; King, Sebastian; Zani, Augusto; Azzie, Georges; Firdouse, Mohammed; Kushwaha, Sameer; Agarwal, Arnav; Bailey, Karen; Cameron, Brian; Livingston, Michael; Horobjowsky, Alexandre; Deckelbaum, Dan L; Razek, Tarek; Marinkovic, Boris; Grasset, Eugenio; D'aguzan, Nicole; Grasset, Eugenio; Jimenez, Julio; Macchiavello, Roberto; Zhang, Zhongtao; Guo, Wei; Oh, Junyeong; Zheng, Fei; Montes, Irene; Sierra, Sebastian; Mendez, Manuela; Villegas, Maria Isabel; Arango, Maria Clara Mendoza; Mendoza, Ivan; Naranjo Aristizã¡bal, Fred Alexander; Botero, Jaime Andres Montoya; Riaza, Victor Manuel Quintero; Restrepo, Jakeline; Morales, Carlos; Arango, Maria Clara Mendoza; Cruz, Herman; Munera, Alejandro; Arango, Maria Clara Mendoza; Karlo, Robert; Domini, Edgar; Mihanovic, Jakov; Radic, Mihael; Zamarin, Kresimir; Pezelj, Nikica; Hache‐Marliere, Manuel; Lemaire, Sylvia Batista; Rivas, Ruben; Khyrallh, Ahmed; Hassan, Ahamed; Shimy, Gamal; Baky Fahmy, Mohamed A; Nabawi, Ayman; Elfil, Mohamed; Ghoneem, Mohamed; Gohar, Muhammad El‐Saied Ahmad Muhammad; Asal, Mohamed; Abdelkader, Mostafa; Gomah, Mahmoud; Rashwan, Hayssam; Karkeet, Mohamed; Gomaa, Ahmed; Hasan, Amr; Elgebaly, Ahmed; Saleh, Omar; Fattah, Ahmad Abdel; Gouda, Abdullah; Elshafay, Abd Elrahman; Gharib, Abdalla; Menshawy, Ahmed; Hanafy, Mohammed; Al‐Mallah, Abdullah; Abdulgawad, Mahmoud; Baheeg, Mohamad; Alhendy, Mohammed; AbdelFattah, Ibrahim; Kenibar, Abdalla; Osman, Omar; Gemeah, Mostafa; Mohammed, Ahmed; Adel, Abdalrahman; Gharib, Abdalla; Mohammed, Abdelrahman; Sayed, Abdelrahman; Abozaid, Mohamed; Kotb, Ahmed Hafez El‐Badri; Ata, Ali Amin Ahmed; Nasr, Mohammed; Alkammash, Abdelrahman; Saeed, Mohammed; El Hamid, Nader Abd; Attia, Attia Mohamed; El Galeel, Ahmed Abd; Elbanby, Eslam; El‐Dien, Khalid Salah; Hantour, Usama; Alahmady, Omar; Mansour, Billal; Elkorashy, Amr Muhammad; Taha, Emad Mohamed Saeed; Lasheen, Kholod Tarek; Elkolaly, Salma Said; Abdel‐Wahab, Nehal Yosri Elsayed; Abozyed, Mahmoud Ahmed Fathi; Adel, Ahmed; Saeed, Ahmed Moustafa; El Sayed, Gehad Samir; Youssif, Jehad Hassan; Ahmed, Soliman Magdy; El‐Shahat, Nermeen Soubhy; Khedr, Abd El‐Rahman Hegazy; Elsebaaye, Abdelrhman Osama; Elzayat, Mohamed; Abdelraheim, Mohamed; Elzayat, Ibrahim; Warda, Mahmoud; El Deen, Khaled Naser; Elnemr, Abdelrhman Essam; Salah, Omar; Abbas, Mohamed; Rashad, Mona; Elzayyat, Ibrahim; Hemeda, Dalia; Tawfik, Gehad; Salama, Mai; Khaled, Hazem; Seisa, Mohamed; Elshaer, Kareem; Hussein, Abdelfatah; Elkhadrawi, Mahmoud; Afifi, Ahmed Mohamed; Ebrahim, Osama Saadeldeen; Metwally, Mahmoud Mohamed; Elmelegy, Rowida; Elsawahly, Diaa Moustafa Elbendary; Safa, Hisham; Nofal, Eman; Elbermawy, Mohamed; Ghazy, Ahmed Abdelmotaleb; Samih, Hisham; Abdelgelil, Asmaa; Abdelghany, Sarah; El Kholy, Ahmed; Aboraya, Metwally; Elkady, Fatma; Salma, Mahmoud; Samy, Sarah; Fakher, Reem; Aboarab, Aya; Samir, Ahmed; Sakr, Ahmed; Haroun, Abdelrahman; Al‐Aarag, Asmaa Abdel‐Rahman; Elkholy, Ahmed; Elshanwany, Sally; Ghanem, Esraa; Tammam, Ahmed; Hammad, Ali Mohamed; El Shoura, Yousra; El Ashal, Gehad; Khairy, Hosni; Antar, Sarah; Mehrez, Sara; Abdelshafy, Mahmoud; Hamad, Maha Gamal Mohamad; Hosh, Mona; Abdallah, Emad; Magdy, Basma; Alzayat, Thuraya; Gamaly, Elsayed; Elfeki, Hossam; Abouzahra, Amany; Elsheikh, Shereen; Elgendy, Fatimah I; El‐Salam, Fathia Abd; Seifelnasr, Osama; Ammar, Mohamed; Eysa, Athar; Sadek, Aliaa; Toeema, Aliaa Gamal; Nasr, Aly; Abuseif, Mohamed; Zidan, Hagar; Barakat, Sara Abd Elmageed; Elsayed, Nadin; Elrasoul, Yasmin Abd; Elkelany, Ahmed; Ammar, Mohamed Sabry; Mustafa, Mennat‐Allah; Hegazy, Yasmin; Etman, Mohamed; Saad, Samar; Alrahawy, Mahmoud; Raslan, Ahmed; Morsi, Mahmoud; Rslan, Ahmed; Sabry, Ahmed; Elwakil, Hager; Shaker, Heba; Zidan, Hagar; Abd‐Elrasoul, Yasmin; Elkelany, Ahmed; El‐Kashef, Hussein; Shaalan, Mohamed; Tarek, Areej; Elwan, Ayman; Nayel, Ahmed Ragab; Seif, Mostafa; Elwan, Ayman; Emadeldin, Doaa; Ghonaim, Mohamed Ali; Almallah, Ahmad; Fouad, Ahmed; Sayma, Eman Adel; Elbatahgy, Ahmad; El‐Ma'doul, Angham Solaiman; Mosad, Ahmed; Tolba, Hager; Elsorogy, Diaa Eldin Abdelazeem Amin; Mostafa, Hassan Ali; Omar, Amira Atef; El Hameed, Ola Sherief Abd; Lasheen, Ahmed; El Salam, Yasser Abd; Morsi, Ashraf; Ismail, Mohammed; El‐badawy, Hager Ahmed; Amer, Mohamed A; Elkelany, Ahmed; Elkelany, Ahmed; El‐Hamouly, Ahmed Sabry; Attallah, Noura A.; Mosalum, Omnia; Afandy, Ahmed; Mokhtar, Ahmed; Abouelnasr, Alaa; Ayad, Sara; Shaker, Ramdan; Sakr, Rokia; Shaker, Ramadan; Amreia, Mahmoud; Elsobky, Soaad; Mustafa, Mohamed; El Magd, Ahmed Abo; Marey, Abeer; Hafez, Amr Tarek; Zalabia, Mohamed F; Mohamed, Mohamed Moamen; Fadel, Amr; Ahmed, Emad Ali; Ali, Ahmad; Alwafai, Mohammad Ghassan; Dwydar, Abdullah; Kharsa, Sara; Mamdouh, Ehab; El‐Sheemy, Hatem; AlYoussef, Ibrahim; Aly, Abouelatta Khairy; Aldalaq, Ahmad; Alnawam, Ehab; Alkhabbaz, Dalia; Saad, Mahmoud; Hussein, Shady; Elazayem, Ahmed Abo; Meshref, Ahmed; Elashmawy, Marwa; Mousa, Mohammed; Nashaat, Ahmad; Ghanem, Sara; Elsayed, Zaynab M; Elwaey, Aya; Elkadsh, Iman; Darweesh, Mariam; Mohameden, Ahmed; Hafez, Mennaallah; Badr, Ahmed; Badwy, Assmaa; El Slam, Mohamed Abd; Elazoul, Mohamed; Al‐Nahrawi, Safwat; Eldamaty, Lotfy; Nada, Fathee; Ameen, Mohamed; Hagar, Aya; Elsehimy, Mohamed; Aboraya, Mohammad; Dawoud, Hossam; El Mesery, Shorouk; El Gendy, Abeer; Abdelkareem, Ahmed; Marey, Ahmed Safwan; Allam, Mostafa; Shehata, Sherif; Abozeid, Khaled; Elshobary, Marwa; Fahiem, Ahmed; Sarsik, Sameh; Hashish, Amel; Zidan, Mohamed; Hashish, Mohamed; Aql, Shaimaa; Elhendawy, Abdelaziz Osman Abdelaziz; Husseini, Mohamed; Kasem, Esraa; Gheith, Ahmed; Elfouly, Yasmin; Soliman, Ahmed Ragab; Ibrahim, Yasmein; Elfouly, Nesma; Fawzy, Ahmed; Hassan, Ahmed; Rashid, Mohammad; Elsherbiny, Abdallah Salah; Sieda, Basem; Badwi, Nermin M; Mohammed, Mohammed Mustafa Hassan; Mohamed, Osama; Habeeb, Mohammad Abdulkhalek; Worku, Mengistu; Starr, Nichole; Desta, Semay; Wondimu, Sahlu; Abebe, Nebyou Seyoum; Thomas, Efeson; Asele, Frehun Ayele; Dabessa, Daniel; Abebe, Nebiyou Seyoum; Zerihun, Abebe Bekele; Mentula, Panu; Leppäniemi, Ari; Sallinen, Ville; Scalabre, Aurelien; Frade, Fernanda; Irtan, Sabine; Graffeille, Vivien; Gaignard, Elodie; Alimi, Quentin; Alimi, Quentin; Graffieille, Vivien; Gaignard, Elodie; Abbo, Olivier; Mouttalib, Sofia; Bouali, Ourdia; Hervieux, Erik; Aigrain, Yves; Botto, Nathalie; Faure, Alice; Fievet, Lucile; Panait, Nicoleta; Eyssartier, Emilie; Schmitt, Francoise; Podevin, Guillaume; Parent, Valentine; Martin, Amandine; Arnaud, Alexis Pierre; Muller, Cecile; Bonnard, Arnaud; Peycelon, Matthieu; Abantanga, Francis; Boakye‐Yiadom, Kwaku; Bukari, Mohammed; Owusu, Frank; Awuku‐Asabre, Joseph; Tabiri, Stephen; Bray, Lemuel Davies; Lytras, Dimitrios; Psarianos, Kyriakos; Bamicha, Anastasia; Kefalidi, Eirini; Gemenetzis, Georgios; Dervenis, Christos; Gouvas, Nikolaos; Agalianos, Christos; Kontos, Michail; Kouraklis, Gregory; Karousos, Dimitrios; Germanos, Stylianos; Marinos, Constantinos; Anthoulakis, Christos; Nikoloudis, Nikolaos; Mitroudis, Nikolaos; Recinos, Gustavo; Estupinian, Sergio; Forno, Walter; Azmitia, José René Arévalo; Cabrera, Carla Cecilia Ramã­rez; Guevara, Romeo; Aguilera, Maria; Mendez, Napoleon; Mendizabal, Cesar Augusto Azmitia; Ramazzini, Pablo; Urquizu, Mario Contreras; Tale, Fernando; Soley, Rafael; Barrios, Emanuel; Barrios, Emmanuel; Rodríguez, Daniel Estuardo Marroquín; Velásquez, Carlos Iván Pérez; Mérida, Sara María Contreras; Regalado, Francisco; Lopez, Mario; Siguantay, Miguel; Lam, Fong Yee; Szeto, Kylie Joan‐yi; Szeto, Charing Cheuk Ling; Li, Wing Sum; Li, Kieran Ka Kei; Leung, Man Fung; Mak, Tony; Ng, Simon; Prasad, SS; Kirishnan, Anand; Gyanchandani, Nidhi; Kumar, Bylapudi Seshu; Rangarajan, Muthukumaran; Bhat, Sriram; Sreedharan, Anjana; Kinnera, S.V.; Reddy, Yella; Venugopal, Caranj; Kumar, Sunil; Mittal, Abhishek; Nadkarni, Shravan; Lakshmi, Harish Neelamraju; Malik, Puneet; Limaye, Neel; Pai, Srinivas; Jain, Pratik; Khajanchi, Monty; Satoskar, Savni; Satoskar, Rajeev; Mahamood, Abid Bin; Sutanto, Eldaa Prisca Refianti; Soeselo, Daniel Ardian; Tedjaatmadja, Chintya; Rahmawati, Fitriana Nur; Amandito, Radhian; Mayasari, Maria; Al‐Hasani, Ruqaya Kadhim Mohammed Jawad; Al‐Hameedi, Hasan Ismael Ibraheem; Ibraheem, Hasan Ismael; Al‐Azraqi, Israa Abdullah Aziz; Sabeeh, Lubna; Kamil, Rahma; Shawki, Marwan; Telfah, Muwaffaq Mezeil; Rasendran, Amoudtha; Sheehan, Jacqueline; Kerley, Robert; Normile, Caoimhe; Gilbert, Richard William; Song, Jiheon; Dablouk, Mohamed; Mauro, Linnea; Dablouk, Mohammed Osman; Hanrahan, Michael; Kielty, Paul; Marks, Eleanor; Gosling, Simon; Mccarthy, Michelle; Rasendran, Amoudtha; Mirghani, Diya; Naqvi, Syed Altaf; Wong, Chee Siong; Chung, Siyi; D'cruz, Reuban; Cahill, Ronan; Gosling, Simon George; Mccarthy, Michelle; Rasendran, Amoudtha; Fahy, Ciara; Song, Jiheon; Hanrahan, Michael; Cadogan, Diana Duarte; Powell, Anna; Gilbert, Richard; Clifford, Caroline; Normile, Caoimhe; Driscoll, Aoife; Paul, Stassen; Lee, Chris; Bowe, Ross; Hutch, William; Hanrahan, Michael; Mohan, Helen; O'neill, Maeve; Mealy, Kenneth; Danelli, Piergiorgio; Bondurri, Andrea; Maffioli, Anna; Pasini, Mario; Pata, Giacomo; Roncali, Stefano; Silvani, Paolo; Carlucci, Michele; Faccincani, Roberto; Bonavina, Luigi; Macchitella, Yuri; Ceriani, Chiara; Tugnoli, Gregorio; Di Saverio, Salomone; Khattab, Khaled; Paludi, Miguel Angel; Pata, Domenica; Cloro, Luigi Maria; Allegri, Andrea; Ansaloni, Luca; Coccolini, Federico; Veronese, Ezio; Bortolasi, Luca; Hasheminia, Alireza; Nastri, Giacomo; Canto, Massimiliano Dal; Cucumazzo, Stefano; Pata, Francesco; Benevento, Angelo; Tessera, Gaetano; Grandinetti, Pier Paolo; Maniscalco, Alessio; Lamanna, Giovanni Luca; Turati, Luca; Sgroi, Giovanni; Rausa, Emanuele; Villa, Roberta; Monteleone, Michela; Merlini, David; Coccolini, Federico; Ansaloni, Luca; Allegri, Andrea; Grassi, Veronica; Cirocchi, Roberto; Cacurri, Alban; Waleed, Hamza; Diab, Ahmed; Elzowawi, Fathi; Jokubauskas, Mantas; Varkalys, Karolis; Venskutonis, Donatas; Pranevicius, Robertas; Ambrozeviciute, Viktorija; Juciute, Simona; Skardžiukaitė, Austė; Venskutonis, Donatas; Bradulskis, Saulius; Urbanavicius, Linas; Austraite, Aiste; Riauka, Romualdas; Zilinskas, Justas; Dambrauskas, Zilvinas; Karumnas, Paulius; Urniezius, Zigmantas; Zilinskiene, Reda; Rudzenskaite, Anele; Usaityte, Ausrine; Montrimaite, Margarita; Kaselis, Nerijus; Strazdas, Andrius; Jokubonis, Kristijonas; Maceviciute, Kornelija; Beisa, Virgilijus; Poskus, Tomas; Strupas, Kestutis; Laugzemys, Erikas; Kolosov, Andrej; Jotautas, Valdemaras; Rakita, Ignas; Mikalauskas, Saulius; Kazanavicius, Darius; Rackauskas, Rokas; Strupas, Kestutis; Poskus, Tomas; Beisa, Virgilijus; Rakauskas, Ritauras; Preckailaite, Egle; Coomber, Ross; Johnson, Kenneth; Nowers, Jennifer; Periasammy, Dineshwary; Salleh, Afizah; Das, Andre; Tze, Reuben Goh Ern; Kumar, Milaksh Nirumal; Abdullah, Nik Azim Nik; Kosai, Nik Ritza; Taher, Mustafa; Rajan, Reynu; Chong, Hoong Yin; Roslani, April Camilla; Goh, Cheng Chun; Agius, Marija; Borg, Elaine; Bezzina, Maureen; Bugeja, Roberta; Vella‐Baldacchino, Martinique; Spina, Andrew; Psaila, Josephine; Francois‐Coridon, Helene; Tolg, Cecilia; Colombani, Jean‐Francois; Diaz‐Zorrilla, Carmina; De La Medina, Antonio Ramos‐; Gonzalez, Samantha Corro‐Diaz; Jacobe, Mário; Mapasse, Domingos; Snyder, Elizabeth; Oumer, Ramadan; Osman, Mohammed; Mohammad, Aminu; Anyanwu, Lofty‐John; Sheshe, Abdulrahman; Adesina, Alaba; Faturoti, Olubukola; Taiwo, Ogechukwu; Ibrahim, Muhammad Habib; Nasir, Abdulrasheed A; Suleiman, Siyaka Itopa; Adeniyi, Adewale; Adesanya, Opeoluwa; Adebanjo, Ademola; Osuoji, Roland; Atobatele, Kazeem; Ogunyemi, Ayokunle; Williams, Omolara; Oludara, Mobolaji; Oshodi, Olabode; Ademuyiwa, Adesoji; Lawal, AbdulRazzaq Oluwagbemiga; Alakaloko, Felix; Elebute, Olumide; Osinowo, Adedapo; Bode, Christopher; Adesuyi, Abidemi; Tade, Adesoji; Adekoya, Adeleke; Nwokoro, Collins; Ayandipo, Omobolaji O; Lawal, Taiwo Akeem; Ajao, Akinlabi E; Ali, Samuel Sani; Odeyemi, Babatunde; Olori, Samson; Popoola, Ademola; Adeyeye, Ademola; Adeniran, James; Lossius, William J.; Havemann, Ingemar; Thorsen, Kenneth; Narvestad, Jon Kristian; Soreide, Kjetil; Wold, Trude Beate; Nymo, Linn; Elsiddig, Mohammed; Dar, Manzoor; Bhopal, Kamran Faisal; Iftikhar, Zainab; Furqan, Muhammad Mohsin; Nighat, Bakhtiar; Jawaid, Masood; Khalique, Abdul; Zil‐E‐Ali, Ahsan; Rashid, Anam; Dharamshi, Hasnain Abbas; Naqvi, Tahira; Faraz, Ahmad; Anwar, Abdul Wahid; Yaseen, Tahir Muhammad; Shamsi, Ghina Shamim; Shamsi, Ghina; Yaseen, Tahir; Anwer, Wahid; Decoud, Horacio Paredes; Aguilera, Omar; Alvarez, Ismael Isaac Zelada; Delgado, Juan Marcelo; Vega, Gustavo Miguel Machain; Lohse, Helmut Alfredo Segovia; Aguilar, Wendy Leslie Messa; Chiong, Jose Antonio Cabala; Bautista, Ana Cecilia Manchego; Huaman, Eduardo; Zegarra, Sergio; Camacho, Rony; Celis, Jose María Vergara; Pozo, Diego Alonso Romani; Hamasaki, José; Temoche, Edilberto; Herrera‐Matta, Jaime; Torres, Carla Pierina García; Barreda, Luis Miguel Alvarez; Ojeda, Ronald Renato Barrionuevo; Garaycochea, Octavio; Mollo, Melanie Castro; Delgado, Mitchelle Solange De Fã Tima Linare; Fujii, Francisco; Bautista, Ana Cecilia Manchego; Aguilar, Wendy Leslie Messa; Chiong, Jose Antonio Cabala; Durand, Susana Yrma Aranzabal; Basto, Carlos Alejandro Arroyo; Rojas, Nelson Manuel Urbina; Yip, Sebastian Bernardo Shu; Vergara, Ana Lucia Contreras; Moran, Andrea Echevarria Rosas; Luque, Giuliano Borda; Castro, Manuel Rodriguez; Jaramillo, Ramon Alvarado; Sila, George Manrique; Lopez, Crislee Elizabeth; De Leon, Mardelangel Zapata Ponze; Machaca, Massiell; Huaraya, Ronald Coasaca; Arenas, Andy; López, Crislee; Puma, Clara Milagros Herrera; Pino, Wilfredo; Hinojosa, Christian; De Leon, Melanie Zapata Ponze; Limache, Susan; Sila, George Manrrique; Rodriguez, Layza‐Alejandra Mercado; Melo, Renato; Costa‐Maia, Jose; Muralha, Nuno; Sauvat, Frederique; Dan, Ionasc; Hogea, Mircea; Eduard, Pandi; Bratu, Razvan‐Matei; Beuran, Mircea; Diaconescu, Ionut‐Bogdan; Martian, Bogdan‐Valeriu; Iordache, Florin‐Mihail; Vartic, Mihaela; Vida, Lucian Corneliu; Muntean, Liviu Iuliu; Mironescu, Aurel Sandu; Nsengimana, Vizir Jean Paul; Niragire, Alice; Ingabire, Jean De La Croix Allen; Niyirera, Eugene; Zanini, Nicola; Jovine, Elio; Landolfo, Giovanni; Alomar, Ibrahim N.; Alnuqaydan, Saleh A.; Altwigry, Abdulrahman M.; Othman, Moayad; Osman, Nohad; Alqahtani, Enas; Alzahrani, Mohammed; Alyami, Rifan; Aljohani, Emad; Alhabli, Ibrahim; Mikwar, Zaher; Almuallem, Sultan; Aljohani, Emad; Alyami, Rifan; Alzahrani, Mohammed; Nawawi, Abrar; Bakhaidar, Mohamad; Maghrabi, Ashraf A.; Alsaggaf, Mohammed; Aljiffry, Murad; Altaf, Abdulmalik; Khoja, Ahmad; Habeebullah, Alaa; Akeel, Nouf; Ghandora, Nashat; Almoflihi, Abdullah; Huwait, Abdulmalik; Al‐shammari, Abeer; Al‐Mousa, Mashael; Alghamdi, Masood; Adham, Walid; Albeladi, Bandar; Alfarsi, Muayad Ahmed; Mahdi, Atif; Al Awwad, Saad; Altamimi, Afnan; Nouh, Thamer; Hassanain, Mazen; Aldhafeeri, Salman; Sadig, Nawal; Algohary, Osama; Aledrisy, Mohannad; Gudal, Ahmad; Alrifaie, Ahmad; AlRowais, Mohammed; Althwainy, Amani; Shabkah, Alaa; Alamoudi, Uthman; Alrajraji, Mawaddah; Alghamdi, Basim; Aljohani, Saud; Daqeeq, Abdullah; Al‐Faifi, Jubran J; Jennings, Vicky; Ngayu, Nyawira

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

3427sinoneBackground: 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 &lt; 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P &lt; 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 &lt; 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P &lt; 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 &lt; 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.noneGlasbey, 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, J.C 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; Chapman, Stephen J; Arnaud, Alexis P; Tabiri, Stephen; Recinos, Gustavo; Manipal, Cutting Edge; Mohan, Midhun; Amandito, Radhian; Shawki, Marwan; Hanrahan, Michael; Pata, Francesco; Zilinskas, Justas; Roslani, April Camilla; Goh, Cheng Chun; Ademuyiwa, Adesoji O; Irwin, Gareth; Shu, Sebastian; Luque, Laura; Shiwani, Hunain; Altamimi, Afnan; Alsaggaf, Mohammed Ubaid; Fergusson, Stuart J; Spence, Richard; Rayne, Sarah; Jeyakumar, Jenifa; Cengiz, Yucel; Raptis, Dmitri A; Glasbey, James C; Modolo, Maria Marta; Iyer, Dushyant; King, Sebastian; Arthur, Tom; Nahar, Sayeda Nazmum; Waterman, Ade; Ismaïl, Lawani; Walsh, Michael; Agarwal, Arnav; Zani, Augusto; Firdouse, Mohammed; Rouse, Tyler; Liu, Qinyang; Correa, Juan Camilo; Salem, Hosni Khairy; Talving, Peep; Worku, Mengistu; Arnaud, Alexis; Tabiri, Stephen; Kalles, Vassilis; Aguilera, Maria Lorena; Recinos, Gustavo; Kumar, Basant; Kumar, Sunil; Amandito, Radhian; Quek, Roy; Pata, Francesco; Ansaloni, Luca; Altibi, Ahmed; Venskutonis, Donatas; Zilinskas, Justas; Poskus, Tomas; Whitaker, John; Msosa, Vanessa; Tew, Yong Yong; Farrugia, Alexia; Borg, Elaine; Medina, Antonio Ramos‐De; Bentounsi, Zineb; Ademuyiwa, Adesoji O; Søreide, Kjetil; Gala, Tanzeela; Al‐Slaibi, Ibrahim; Tahboub, Haya; Alser, Osaid H.; Romani, Diego; Shu, Sebestian; Major, Piotr; Mironescu, Aurel; Bratu, Matei; Kourdouli, Amar; Ndajiwo, Aliyu; Altwijri, Abdulaziz; Alsaggaf, Mohammed Ubaid; Gudal, Ahmad; Jubran, Al Faifi; Seisay, Sam; Lieske, Bettina; Rayne, Sarah; Spence, Richard; Ortega, Irene; Jeyakumar, Jenifa; Senanayake, Kithsiri J.; Abdulbagi, Omar; Cengiz, Yucel; Raptis, Dmitri; Altinel, Yuksel; Kong, Chia; Teasdale, Ella; Irwin, Gareth; Stoddart, Michael; Kabariti, Rakan; Suresh, Sukrit; Gash, Katherine; Narayanan, Ragavan; Maimbo, Mayaba; Fermani, Claudio; Balmaceda, Ruben; Modolo, Maria Marta; Macdermid, Ewan; Gobin, Neel; Chenn, Roxanne; Yong, Cheryl Ou; Edye, Michael; Jarmin, Martin; D'amours, Scott K; Iyer, Dushyant; Youssef, Daniel; Phillips, Nicholas; Brown, Jason; George, Robert; Koh, Cherry; Warren, Oliver; Hanley, Isaac; Dickfos, Marilla; Nawara, Clemens; Öfner, Dietmar; Primavesi, Florian; Mitul, Ashrarur Rahman; Mahmud, Khalid; Hussain, Margub; Hakim, Hafiz; Kumar, Tapan; Oosterkamp, Antje; Assouto, Pamphile A; Lawani, Ismail; Souaibou, Yacoubou Imorou; Tun, Aung Kyaw; Chong, Chean Leung; Devadasar, Giridhar H; Chong, Chean Leung; Qadir, Muhammad Rashid Minhas; Aung, Kyaw Phyo; Yeo, Lee Shi; Chong, Chean Leung; Castillo, Vanessa Dina Palomino; Munhoz, Monique Moron; Moreira, Gisele; De Castro Segundo, Luiz Carlos Barros; Ferreira, Salim Anderson Khouri; Careta, Maíra Cassa; Kim, Stella Binna; De Sousa, Alexandre Venancio; Cury, Alyne Daltri Lazzarini; Miguel, Gustavo Peixoto Soares; De Freitas, Ana Vega Carreiro; Guasti, Barbara Pereira Silvestre Julia; Vianna, Pinto; Felipe, Carolina Oliveira; Laufer, Luis Alberto Valente; Altoe, Fernanda; Da Silva, Luana Ayres; Pimenta, Marina Luiza; Giuriato, Thiago Fernandes; Morais, Paulo Alves Bezerra; Araujo, Jessica Souza Luiz Rafael; Menegussi, Juliana; Leal, Marisa; Lima, Caio Vinícius Barroso; Tatagiba, Luiza Sarmento; Leal, Antônio; Santos, Diogo Vinicius; Fraga, Gustavo Pereira; Simoes, Romeo Lages; Stock, Simon; Nigo, Samuel; Kabba, Juana; Ngwa, Tagang Ebogo; Brown, James; King, Sebastian; Zani, Augusto; Azzie, Georges; Firdouse, Mohammed; Kushwaha, Sameer; Agarwal, Arnav; Bailey, Karen; Cameron, Brian; Livingston, Michael; Horobjowsky, Alexandre; Deckelbaum, Dan L; Razek, Tarek; Marinkovic, Boris; Grasset, Eugenio; D'aguzan, Nicole; Grasset, Eugenio; Jimenez, Julio; Macchiavello, Roberto; Zhang, Zhongtao; Guo, Wei; Oh, Junyeong; Zheng, Fei; Montes, Irene; Sierra, Sebastian; Mendez, Manuela; Villegas, Maria Isabel; Arango, Maria Clara Mendoza; Mendoza, Ivan; Naranjo Aristizã¡bal, Fred Alexander; Botero, Jaime Andres Montoya; Riaza, Victor Manuel Quintero; Restrepo, Jakeline; Morales, Carlos; Arango, Maria Clara Mendoza; Cruz, Herman; Munera, Alejandro; Arango, Maria Clara Mendoza; Karlo, Robert; Domini, Edgar; Mihanovic, Jakov; Radic, Mihael; Zamarin, Kresimir; Pezelj, Nikica; Hache‐Marliere, Manuel; Lemaire, Sylvia Batista; Rivas, Ruben; Khyrallh, Ahmed; Hassan, Ahamed; Shimy, Gamal; Baky Fahmy, Mohamed A; Nabawi, Ayman; Elfil, Mohamed; Ghoneem, Mohamed; Gohar, Muhammad El‐Saied Ahmad Muhammad; Asal, Mohamed; Abdelkader, Mostafa; Gomah, Mahmoud; Rashwan, Hayssam; Karkeet, Mohamed; Gomaa, Ahmed; Hasan, Amr; Elgebaly, Ahmed; Saleh, Omar; Fattah, Ahmad Abdel; Gouda, Abdullah; Elshafay, Abd Elrahman; Gharib, Abdalla; Menshawy, Ahmed; Hanafy, Mohammed; Al‐Mallah, Abdullah; Abdulgawad, Mahmoud; Baheeg, Mohamad; Alhendy, Mohammed; AbdelFattah, Ibrahim; Kenibar, Abdalla; Osman, Omar; Gemeah, Mostafa; Mohammed, Ahmed; Adel, Abdalrahman; Gharib, Abdalla; Mohammed, Abdelrahman; Sayed, Abdelrahman; Abozaid, Mohamed; Kotb, Ahmed Hafez El‐Badri; Ata, Ali Amin Ahmed; Nasr, Mohammed; Alkammash, Abdelrahman; Saeed, Mohammed; El Hamid, Nader Abd; Attia, Attia Mohamed; El Galeel, Ahmed Abd; Elbanby, Eslam; El‐Dien, Khalid Salah; Hantour, Usama; Alahmady, Omar; Mansour, Billal; Elkorashy, Amr Muhammad; Taha, Emad Mohamed Saeed; Lasheen, Kholod Tarek; Elkolaly, Salma Said; Abdel‐Wahab, Nehal Yosri Elsayed; Abozyed, Mahmoud Ahmed Fathi; Adel, Ahmed; Saeed, Ahmed Moustafa; El Sayed, Gehad Samir; Youssif, Jehad Hassan; Ahmed, Soliman Magdy; El‐Shahat, Nermeen Soubhy; Khedr, Abd El‐Rahman Hegazy; Elsebaaye, Abdelrhman Osama; Elzayat, Mohamed; Abdelraheim, Mohamed; Elzayat, Ibrahim; Warda, Mahmoud; El Deen, Khaled Naser; Elnemr, Abdelrhman Essam; Salah, Omar; Abbas, Mohamed; Rashad, Mona; Elzayyat, Ibrahim; Hemeda, Dalia; Tawfik, Gehad; Salama, Mai; Khaled, Hazem; Seisa, Mohamed; Elshaer, Kareem; Hussein, Abdelfatah; Elkhadrawi, Mahmoud; Afifi, Ahmed Mohamed; Ebrahim, Osama Saadeldeen; Metwally, Mahmoud Mohamed; Elmelegy, Rowida; Elsawahly, Diaa Moustafa Elbendary; Safa, Hisham; Nofal, Eman; Elbermawy, Mohamed; Ghazy, Ahmed Abdelmotaleb; Samih, Hisham; Abdelgelil, Asmaa; Abdelghany, Sarah; El Kholy, Ahmed; Aboraya, Metwally; Elkady, Fatma; Salma, Mahmoud; Samy, Sarah; Fakher, Reem; Aboarab, Aya; Samir, Ahmed; Sakr, Ahmed; Haroun, Abdelrahman; Al‐Aarag, Asmaa Abdel‐Rahman; Elkholy, Ahmed; Elshanwany, Sally; Ghanem, Esraa; Tammam, Ahmed; Hammad, Ali Mohamed; El Shoura, Yousra; El Ashal, Gehad; Khairy, Hosni; Antar, Sarah; Mehrez, Sara; Abdelshafy, Mahmoud; Hamad, Maha Gamal Mohamad; Hosh, Mona; Abdallah, Emad; Magdy, Basma; Alzayat, Thuraya; Gamaly, Elsayed; Elfeki, Hossam; Abouzahra, Amany; Elsheikh, Shereen; Elgendy, Fatimah I; El‐Salam, Fathia Abd; Seifelnasr, Osama; Ammar, Mohamed; Eysa, Athar; Sadek, Aliaa; Toeema, Aliaa Gamal; Nasr, Aly; Abuseif, Mohamed; Zidan, Hagar; Barakat, Sara Abd Elmageed; Elsayed, Nadin; Elrasoul, Yasmin Abd; Elkelany, Ahmed; Ammar, Mohamed Sabry; Mustafa, Mennat‐Allah; Hegazy, Yasmin; Etman, Mohamed; Saad, Samar; Alrahawy, Mahmoud; Raslan, Ahmed; Morsi, Mahmoud; Rslan, Ahmed; Sabry, Ahmed; Elwakil, Hager; Shaker, Heba; Zidan, Hagar; Abd‐Elrasoul, Yasmin; Elkelany, Ahmed; El‐Kashef, Hussein; Shaalan, Mohamed; Tarek, Areej; Elwan, Ayman; Nayel, Ahmed Ragab; Seif, Mostafa; Elwan, Ayman; Emadeldin, Doaa; Ghonaim, Mohamed Ali; Almallah, Ahmad; Fouad, Ahmed; Sayma, Eman Adel; Elbatahgy, Ahmad; El‐Ma'doul, Angham Solaiman; Mosad, Ahmed; Tolba, Hager; Elsorogy, Diaa Eldin Abdelazeem Amin; Mostafa, Hassan Ali; Omar, Amira Atef; El Hameed, Ola Sherief Abd; Lasheen, Ahmed; El Salam, Yasser Abd; Morsi, Ashraf; Ismail, Mohammed; El‐badawy, Hager Ahmed; Amer, Mohamed A; Elkelany, Ahmed; Elkelany, Ahmed; El‐Hamouly, Ahmed Sabry; Attallah, Noura A.; Mosalum, Omnia; Afandy, Ahmed; Mokhtar, Ahmed; Abouelnasr, Alaa; Ayad, Sara; Shaker, Ramdan; Sakr, Rokia; Shaker, Ramadan; Amreia, Mahmoud; Elsobky, Soaad; Mustafa, Mohamed; El Magd, Ahmed Abo; Marey, Abeer; Hafez, Amr Tarek; Zalabia, Mohamed F; Mohamed, Mohamed Moamen; Fadel, Amr; Ahmed, Emad Ali; Ali, Ahmad; Alwafai, Mohammad Ghassan; Dwydar, Abdullah; Kharsa, Sara; Mamdouh, Ehab; El‐Sheemy, Hatem; AlYoussef, Ibrahim; Aly, Abouelatta Khairy; Aldalaq, Ahmad; Alnawam, Ehab; Alkhabbaz, Dalia; Saad, Mahmoud; Hussein, Shady; Elazayem, Ahmed Abo; Meshref, Ahmed; Elashmawy, Marwa; Mousa, Mohammed; Nashaat, Ahmad; Ghanem, Sara; Elsayed, Zaynab M; Elwaey, Aya; Elkadsh, Iman; Darweesh, Mariam; Mohameden, Ahmed; Hafez, Mennaallah; Badr, Ahmed; Badwy, Assmaa; El Slam, Mohamed Abd; Elazoul, Mohamed; Al‐Nahrawi, Safwat; Eldamaty, Lotfy; Nada, Fathee; Ameen, Mohamed; Hagar, Aya; Elsehimy, Mohamed; Aboraya, Mohammad; Dawoud, Hossam; El Mesery, Shorouk; El Gendy, Abeer; Abdelkareem, Ahmed; Marey, Ahmed Safwan; Allam, Mostafa; Shehata, Sherif; Abozeid, Khaled; Elshobary, Marwa; Fahiem, Ahmed; Sarsik, Sameh; Hashish, Amel; Zidan, Mohamed; Hashish, Mohamed; Aql, Shaimaa; Elhendawy, Abdelaziz Osman Abdelaziz; Husseini, Mohamed; Kasem, Esraa; Gheith, Ahmed; Elfouly, Yasmin; Soliman, Ahmed Ragab; Ibrahim, Yasmein; Elfouly, Nesma; Fawzy, Ahmed; Hassan, Ahmed; Rashid, Mohammad; Elsherbiny, Abdallah Salah; Sieda, Basem; Badwi, Nermin M; Mohammed, Mohammed Mustafa Hassan; Mohamed, Osama; Habeeb, Mohammad Abdulkhalek; Worku, Mengistu; Starr, Nichole; Desta, Semay; Wondimu, Sahlu; Abebe, Nebyou Seyoum; Thomas, Efeson; Asele, Frehun Ayele; Dabessa, Daniel; Abebe, Nebiyou Seyoum; Zerihun, Abebe Bekele; Mentula, Panu; Leppäniemi, Ari; Sallinen, Ville; Scalabre, Aurelien; Frade, Fernanda; Irtan, Sabine; Graffeille, Vivien; Gaignard, Elodie; Alimi, Quentin; Alimi, Quentin; Graffieille, Vivien; Gaignard, Elodie; Abbo, Olivier; Mouttalib, Sofia; Bouali, Ourdia; Hervieux, Erik; Aigrain, Yves; Botto, Nathalie; Faure, Alice; Fievet, Lucile; Panait, Nicoleta; Eyssartier, Emilie; Schmitt, Francoise; Podevin, Guillaume; Parent, Valentine; Martin, Amandine; Arnaud, Alexis Pierre; Muller, Cecile; Bonnard, Arnaud; Peycelon, Matthieu; Abantanga, Francis; Boakye‐Yiadom, Kwaku; Bukari, Mohammed; Owusu, Frank; Awuku‐Asabre, Joseph; Tabiri, Stephen; Bray, Lemuel Davies; Lytras, Dimitrios; Psarianos, Kyriakos; Bamicha, Anastasia; Kefalidi, Eirini; Gemenetzis, Georgios; Dervenis, Christos; Gouvas, Nikolaos; Agalianos, Christos; Kontos, Michail; Kouraklis, Gregory; Karousos, Dimitrios; Germanos, Stylianos; Marinos, Constantinos; Anthoulakis, Christos; Nikoloudis, Nikolaos; Mitroudis, Nikolaos; Recinos, Gustavo; Estupinian, Sergio; Forno, Walter; Azmitia, José René Arévalo; Cabrera, Carla Cecilia Ramã­rez; Guevara, Romeo; Aguilera, Maria; Mendez, Napoleon; Mendizabal, Cesar Augusto Azmitia; Ramazzini, Pablo; Urquizu, Mario Contreras; Tale, Fernando; Soley, Rafael; Barrios, Emanuel; Barrios, Emmanuel; Rodríguez, Daniel Estuardo Marroquín; Velásquez, Carlos Iván Pérez; Mérida, Sara María Contreras; Regalado, Francisco; Lopez, Mario; Siguantay, Miguel; Lam, Fong Yee; Szeto, Kylie Joan‐yi; Szeto, Charing Cheuk Ling; Li, Wing Sum; Li, Kieran Ka Kei; Leung, Man Fung; Mak, Tony; Ng, Simon; Prasad, SS; Kirishnan, Anand; Gyanchandani, Nidhi; Kumar, Bylapudi Seshu; Rangarajan, Muthukumaran; Bhat, Sriram; Sreedharan, Anjana; Kinnera, S.V.; Reddy, Yella; Venugopal, Caranj; Kumar, Sunil; Mittal, Abhishek; Nadkarni, Shravan; Lakshmi, Harish Neelamraju; Malik, Puneet; Limaye, Neel; Pai, Srinivas; Jain, Pratik; Khajanchi, Monty; Satoskar, Savni; Satoskar, Rajeev; Mahamood, Abid Bin; Sutanto, Eldaa Prisca Refianti; Soeselo, Daniel Ardian; Tedjaatmadja, Chintya; Rahmawati, Fitriana Nur; Amandito, Radhian; Mayasari, Maria; Al‐Hasani, Ruqaya Kadhim Mohammed Jawad; Al‐Hameedi, Hasan Ismael Ibraheem; Ibraheem, Hasan Ismael; Al‐Azraqi, Israa Abdullah Aziz; Sabeeh, Lubna; Kamil, Rahma; Shawki, Marwan; Telfah, Muwaffaq Mezeil; Rasendran, Amoudtha; Sheehan, Jacqueline; Kerley, Robert; Normile, Caoimhe; Gilbert, Richard William; Song, Jiheon; Dablouk, Mohamed; Mauro, Linnea; Dablouk, Mohammed Osman; Hanrahan, Michael; Kielty, Paul; Marks, Eleanor; Gosling, Simon; Mccarthy, Michelle; Rasendran, Amoudtha; Mirghani, Diya; Naqvi, Syed Altaf; Wong, Chee Siong; Chung, Siyi; D'cruz, Reuban; Cahill, Ronan; Gosling, Simon George; Mccarthy, Michelle; Rasendran, Amoudtha; Fahy, Ciara; Song, Jiheon; Hanrahan, Michael; Cadogan, Diana Duarte; Powell, Anna; Gilbert, Richard; Clifford, Caroline; Normile, Caoimhe; Driscoll, Aoife; Paul, Stassen; Lee, Chris; Bowe, Ross; Hutch, William; Hanrahan, Michael; Mohan, Helen; O'neill, Maeve; Mealy, Kenneth; Danelli, Piergiorgio; Bondurri, Andrea; Maffioli, Anna; Pasini, Mario; Pata, Giacomo; Roncali, Stefano; Silvani, Paolo; Carlucci, Michele; Faccincani, Roberto; Bonavina, Luigi; Macchitella, Yuri; Ceriani, Chiara; Tugnoli, Gregorio; Di Saverio, Salomone; Khattab, Khaled; Paludi, Miguel Angel; Pata, Domenica; Cloro, Luigi Maria; Allegri, Andrea; Ansaloni, Luca; Coccolini, Federico; Veronese, Ezio; Bortolasi, Luca; Hasheminia, Alireza; Nastri, Giacomo; Canto, Massimiliano Dal; Cucumazzo, Stefano; Pata, Francesco; Benevento, Angelo; Tessera, Gaetano; Grandinetti, Pier Paolo; Maniscalco, Alessio; Lamanna, Giovanni Luca; Turati, Luca; Sgroi, Giovanni; Rausa, Emanuele; Villa, Roberta; Monteleone, Michela; Merlini, David; Coccolini, Federico; Ansaloni, Luca; Allegri, Andrea; Grassi, Veronica; Cirocchi, Roberto; Cacurri, Alban; Waleed, Hamza; Diab, Ahmed; Elzowawi, Fathi; Jokubauskas, Mantas; Varkalys, Karolis; Venskutonis, Donatas; Pranevicius, Robertas; Ambrozeviciute, Viktorija; Juciute, Simona; Skardžiukaitė, Austė; Venskutonis, Donatas; Bradulskis, Saulius; Urbanavicius, Linas; Austraite, Aiste; Riauka, Romualdas; Zilinskas, Justas; Dambrauskas, Zilvinas; Karumnas, Paulius; Urniezius, Zigmantas; Zilinskiene, Reda; Rudzenskaite, Anele; Usaityte, Ausrine; Montrimaite, Margarita; Kaselis, Nerijus; Strazdas, Andrius; Jokubonis, Kristijonas; Maceviciute, Kornelija; Beisa, Virgilijus; Poskus, Tomas; Strupas, Kestutis; Laugzemys, Erikas; Kolosov, Andrej; Jotautas, Valdemaras; Rakita, Ignas; Mikalauskas, Saulius; Kazanavicius, Darius; Rackauskas, Rokas; Strupas, Kestutis; Poskus, Tomas; Beisa, Virgilijus; Rakauskas, Ritauras; Preckailaite, Egle; Coomber, Ross; Johnson, Kenneth; Nowers, Jennifer; Periasammy, Dineshwary; Salleh, Afizah; Das, Andre; Tze, Reuben Goh Ern; Kumar, Milaksh Nirumal; Abdullah, Nik Azim Nik; Kosai, Nik Ritza; Taher, Mustafa; Rajan, Reynu; Chong, Hoong Yin; Roslani, April Camilla; Goh, Cheng Chun; Agius, Marija; Borg, Elaine; Bezzina, Maureen; Bugeja, Roberta; Vella‐Baldacchino, Martinique; Spina, Andrew; Psaila, Josephine; Francois‐Coridon, Helene; Tolg, Cecilia; Colombani, Jean‐Francois; Diaz‐Zorrilla, Carmina; De La Medina, Antonio Ramos‐; Gonzalez, Samantha Corro‐Diaz; Jacobe, Mário; Mapasse, Domingos; Snyder, Elizabeth; Oumer, Ramadan; Osman, Mohammed; Mohammad, Aminu; Anyanwu, Lofty‐John; Sheshe, Abdulrahman; Adesina, Alaba; Faturoti, Olubukola; Taiwo, Ogechukwu; Ibrahim, Muhammad Habib; Nasir, Abdulrasheed A; Suleiman, Siyaka Itopa; Adeniyi, Adewale; Adesanya, Opeoluwa; Adebanjo, Ademola; Osuoji, Roland; Atobatele, Kazeem; Ogunyemi, Ayokunle; Williams, Omolara; Oludara, Mobolaji; Oshodi, Olabode; Ademuyiwa, Adesoji; Lawal, AbdulRazzaq Oluwagbemiga; Alakaloko, Felix; Elebute, Olumide; Osinowo, Adedapo; Bode, Christopher; Adesuyi, Abidemi; Tade, Adesoji; Adekoya, Adeleke; Nwokoro, Collins; Ayandipo, Omobolaji O; Lawal, Taiwo Akeem; Ajao, Akinlabi E; Ali, Samuel Sani; Odeyemi, Babatunde; Olori, Samson; Popoola, Ademola; Adeyeye, Ademola; Adeniran, James; Lossius, William J.; Havemann, Ingemar; Thorsen, Kenneth; Narvestad, Jon Kristian; Soreide, Kjetil; Wold, Trude Beate; Nymo, Linn; Elsiddig, Mohammed; Dar, Manzoor; Bhopal, Kamran Faisal; Iftikhar, Zainab; Furqan, Muhammad Mohsin; Nighat, Bakhtiar; Jawaid, Masood; Khalique, Abdul; Zil‐E‐Ali, Ahsan; Rashid, Anam; Dharamshi, Hasnain Abbas; Naqvi, Tahira; Faraz, Ahmad; Anwar, Abdul Wahid; Yaseen, Tahir Muhammad; Shamsi, Ghina Shamim; Shamsi, Ghina; Yaseen, Tahir; Anwer, Wahid; Decoud, Horacio Paredes; Aguilera, Omar; Alvarez, Ismael Isaac Zelada; Delgado, Juan Marcelo; Vega, Gustavo Miguel Machain; Lohse, Helmut Alfredo Segovia; Aguilar, Wendy Leslie Messa; Chiong, Jose Antonio Cabala; Bautista, Ana Cecilia Manchego; Huaman, Eduardo; Zegarra, Sergio; Camacho, Rony; Celis, Jose María Vergara; Pozo, Diego Alonso Romani; Hamasaki, José; Temoche, Edilberto; Herrera‐Matta, Jaime; Torres, Carla Pierina García; Barreda, Luis Miguel Alvarez; Ojeda, Ronald Renato Barrionuevo; Garaycochea, Octavio; Mollo, Melanie Castro; Delgado, Mitchelle Solange De Fã Tima Linare; Fujii, Francisco; Bautista, Ana Cecilia Manchego; Aguilar, Wendy Leslie Messa; Chiong, Jose Antonio Cabala; Durand, Susana Yrma Aranzabal; Basto, Carlos Alejandro Arroyo; Rojas, Nelson Manuel Urbina; Yip, Sebastian Bernardo Shu; Vergara, Ana Lucia Contreras; Moran, Andrea Echevarria Rosas; Luque, Giuliano Borda; Castro, Manuel Rodriguez; Jaramillo, Ramon Alvarado; Sila, George Manrique; Lopez, Crislee Elizabeth; De Leon, Mardelangel Zapata Ponze; Machaca, Massiell; Huaraya, Ronald Coasaca; Arenas, Andy; López, Crislee; Puma, Clara Milagros Herrera; Pino, Wilfredo; Hinojosa, Christian; De Leon, Melanie Zapata Ponze; Limache, Susan; Sila, George Manrrique; Rodriguez, Layza‐Alejandra Mercado; Melo, Renato; Costa‐Maia, Jose; Muralha, Nuno; Sauvat, Frederique; Dan, Ionasc; Hogea, Mircea; Eduard, Pandi; Bratu, Razvan‐Matei; Beuran, Mircea; Diaconescu, Ionut‐Bogdan; Martian, Bogdan‐Valeriu; Iordache, Florin‐Mihail; Vartic, Mihaela; Vida, Lucian Corneliu; Muntean, Liviu Iuliu; Mironescu, Aurel Sandu; Nsengimana, Vizir Jean Paul; Niragire, Alice; Ingabire, Jean De La Croix Allen; Niyirera, Eugene; Zanini, Nicola; Jovine, Elio; Landolfo, Giovanni; Alomar, Ibrahim N.; Alnuqaydan, Saleh A.; Altwigry, Abdulrahman M.; Othman, Moayad; Osman, Nohad; Alqahtani, Enas; Alzahrani, Mohammed; Alyami, Rifan; Aljohani, Emad; Alhabli, Ibrahim; Mikwar, Zaher; Almuallem, Sultan; Aljohani, Emad; Alyami, Rifan; Alzahrani, Mohammed; Nawawi, Abrar; Bakhaidar, Mohamad; Maghrabi, Ashraf A.; Alsaggaf, Mohammed; Aljiffry, Murad; Altaf, Abdulmalik; Khoja, Ahmad; Habeebullah, Alaa; Akeel, Nouf; Ghandora, Nashat; Almoflihi, Abdullah; Huwait, Abdulmalik; Al‐shammari, Abeer; Al‐Mousa, Mashael; Alghamdi, Masood; Adham, Walid; Albeladi, Bandar; Alfarsi, Muayad Ahmed; Mahdi, Atif; Al Awwad, Saad; Altamimi, Afnan; Nouh, Thamer; Hassanain, Mazen; Aldhafeeri, Salman; Sadig, Nawal; Algohary, Osama; Aledrisy, Mohannad; Gudal, Ahmad; Alrifaie, Ahmad; AlRowais, Mohammed; Althwainy, Amani; Shabkah, Alaa; Alamoudi, Uthman; Alrajraji, Mawaddah; Alghamdi, Basim; Aljohani, Saud; Daqeeq, Abdullah; Al‐Faifi, Jubran J; Jennings, Vicky;