5 research outputs found

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

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    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路9 per cent) from low-HDI, 254 (15路5 per cent) from middle-HDI and 1268 (77路6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57路5, 40路9 and 35路4 per cent; P < 0路001) and subsequent use of end colostomy (52路2, 24路8 and 18路9 per cent; P < 0路001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3路20, 95 per cent c.i. 1路35 to 7路57; P = 0路008) after risk adjustment for malignant disease (OR 2路34, 1路65 to 3路32; P < 0路001), emergency surgery (OR 4路08, 2路73 to 6路10; P < 0路001), time to operation at least 48 h (OR 1路99, 1路28 to 3路09; P = 0路002) and disease perforation (OR 4路00, 2路81 to 5路69; P < 0路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
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