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

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

Many eyes on the ground: citizen science is an effective early detection tool for biosecurity

Early detection of target non-indigenous species is one of the most important determinants of a successful eradication campaign. For early detection to be successful, and provide the highest probability of achieving eradication, intense surveillance is often required that can involve significant resources. Volunteer based monitoring or “citizen science” is one potential tool to address this problem. This study differs from standard citizen science projects because the participants are personnel or contractors of a company working on Barrow Island, Western Australia. We show that personnel can contribute successfully to a surveillance program aimed at detecting a broad taxonomic range of non-indigenous vertebrate and invertebrate species. Using data collected over a five year surveillance period on Barrow Island, we show that eighteen of the nineteen (95%) non-indigenous invertebrate species new to the island were detected by personnel working on the island, and that the number of detections made by these workers was significantly related to the number of personnel on the island at any one time. Most personnel detections (91%) were made inside buildings where the majority of active surveillance tools could not be implemented. For vertebrates, 4 NIS species detections (100% of detections) were made in the built environment by personnel. Although reporting of suspect non-indigenous species is voluntary, personnel are required to attend inductions and toolboxes where reporting of suspect biosecurity risk material is encouraged. These results demonstrate the value of industry led ‘citizen science’ programs, resulting in sustained stewardship and conservation of areas with high environmental value