Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study
Version 2 2024-06-19, 19:24
Version 1 2023-06-09, 04:33
journal contribution
posted on 2024-06-19, 19:24 authored by Thomas M Drake, Julian Camilleri-Brennan, Stephen Tabiri, Stuart J Fergusson, Richard Spence, J Edward F Fitzgerald, Aneel Bhangu, Ewen M Harrison, Adesoji O Ademuyiwa, Stuart Fergusson, James C Glasbey, Chetan Khatri, Midhun Mohan, Dmitri Nepogodiev, Kjetil Soreide, Neel Gobin, Ana Vega Freitas, Nigel Hall, Sung-Hee Kim, Ahmed Negida, Zahra Jaffry, Stephen J Chapman, Alexis P Arnaud, Gustavo Recinos, Cutting Edge Manipal, Radhian Amandito, Marwan Shawki, Michael Hanrahan, Francesco Pata, Justas Zilinskas, April Camilla Roslani, Cheng Chun Goh, Gareth Irwin, Sebastian Shu, Laura Luque, Hunain Shiwani, Afnan Altamimi, Mohammed Ubaid Alsaggaf, Sarah Rayne, Jenifa Jeyakumar, Yucel Cengiz, Dmitri A Raptis, Claudio Fermani, Ruben Balmaceda, Maria Marta Modolo, Ewan Macdermid, Roxanne Chenn, Cheryl Ou Yong, Michael Edye, Martin Jarmin, Scott K D'amours, Dushyant Iyer, Daniel Youssef, Nicholas Phillips, Jason Brown, Robert George, Cherry Koh, Oliver Warren, Isaac Hanley, Marilla Dickfos, Clemens Nawara, Dietmar Oefner, Florian Primavesi, Ashrarur Rahman Mitul, Khalid Mahmud, Margub Hussain, Hafiz Hakim, Tapan Kumar, Antje Oosterkamp, Pamphile A Assouto, Ismail Lawani, Yacoubou Imorou Souaibou, Aung Kyaw Tun, Chean Leung Chong, Giridhar H Devadasar, Muhammad Rashid Minhas Qadir, Kyaw Phyo Aung, Lee Shi Yeo, Vanessa Dina Palomino Castillo, Monique Moron Munhoz, Gisele Moreira, Luiz Carlos Barros De Castro Segundo, Salim Anderson Khouri Ferreira, Maira Cassa Careta, Stella Binna Kim, Alexandre Venancio De Sousa, Alyne Daltri Lazzarini Cury, Gustavo Peixoto Soares Miguel, Ana Vega Carreiro De Freitas, Barbara Pereira Silvestre, Julia Guasti Pinto Vianna, Carolina Oliveira Felipe, Luis Alberto Valente Laufer, Fernanda Altoe, Luana Ayres Da Silva, Marina Luiza Pimenta, Thiago Fernandes Giuriato, Paulo Alves Bezerra Morais, Jessica Souza Luiz, Rafael Araujo, Juliana Menegussi, Marisa Leal, Caio Vinicius Barroso de Lima, Luiza Sarmento Tatagiba, Antonio Leal, Diogo Vinicius dos Santos, Gustavo Pereira Fraga, Romeo Lages Simoes, Simon Stock, Samuel Nigo, Juana Kabba, Tagang Ebogo Ngwa, James Brown, Sebastian King, Augusto Zani, Georges Azzie, Mohammed Firdouse, Sameer Kushwaha, Arnav Agarwal, Karen Bailey, Brian Cameron, Michael Livingston, Alexandre Horobjowsky, Dan L Deckelbaum, Tarek Razek, Boris Marinkovic, Eugenio Grasset, Nicole D'aguzan, Julio Jimenez, Roberto Macchiavello, Zhongtao Zhang, Wei Guo, Junyeong Oh, Fei Zheng, Irene Montes, Sebastian Sierra, Manuela Mendez, Maria Isabel Villegas, Maria Clara Mendoza Arango, Ivan Mendoza, Fred Alexander Naranjo Aristizabal, Jaime Andres Montoya Botero, Victor Manuel Quintero Riaza, Jakeline Restrepo, Carlos Morales, Herman Cruz, Alejandro Munera, Robert Karlo, Edgar Domini, Jakov Mihanovic, Mihael Radic, Kresimir Zamarin, Nikica Pezelj, Manuel Hache-Marliere, Sylvia Batista Lemaire, Ruben Rivas, Ahmed Khyrallh, Ahamed Hassan, Gamal Shimy, Mohamed A Baky Fahmy, Ayman Nabawi, Mohamed Elfil, Mohamed Ghoneem, Muhammad El-Saied Ahmad Muhammad Gohar, Mohamed Asal, Mostafa Abdelkader, Mahmoud Gomah, Hayssam Rashwan, Mohamed Karkeet, Ahmed Gomaa, Amr Hasan, Ahmed Elgebaly, Omar Saleh, Ahmad Abdel Fattah, Abdullah Gouda, Abd Elrahman Elshafay, Abdalla Gharib, Ahmed Menshawy, Mohammed Hanafy, Abdullah Al-Mallah, Mahmoud Abdulgawad, Mohamad Baheeg, Mohammed Alhendy, Ibrahim AbdelFattah, Abdalla Kenibar, Omar Osman, Mostafa Gemeah, Ahmed Mohammed, Abdalrahman Adel, Abdelrahman Mohammed, Abdelrahman Sayed, Mohamed Abozaid, Ahmed Hafez El-Badri Kotb, Ali Amin Ahmed Ata, Mohammed Nasr, Abdelrahman Alkammash, Mohammed Saeed, Nader Abd El Hamid, Attia Mohamed Attia, Ahmed Abd El Galeel, Eslam Elbanby, Khalid Salah El-Dien, Usama Hantour, Omar Alahmady, Billal Mansour, Amr Muhammad Elkorashy, Emad Mohamed Saeed Taha, Kholod Tarek Lasheen, Salma Said Elkolaly, Nehal Yosri Elsayed Abdel-Wahab, Mahmoud Ahmed Fathi Abozyed, Ahmed Adel, Ahmed Moustafa Saeed, Gehad Samir El Sayed, Jehad Hassan Youssif, Soliman Magdy Ahmed, Nermeen Soubhy El-Shahat, Abd El-Rahman Hegazy Khedr, Abdelrhman Osama Elsebaaye, Mohamed Elzayat, Mohamed Abdelraheim, Ibrahim Elzayat, Mahmoud Warda, Khaled Naser El Deen, Abdelrhman Essam Elnemr, Omar Salah, Mohamed Abbas, Mona Rashad, Ibrahim Elzayyat, Dalia Hemeda, Gehad Tawfik, Mai Salama, Hazem Khaled, Mohamed Seisa, Kareem Elshaer, Abdelfatah Hussein, Mahmoud Elkhadrawi, Ahmed Mohamed Afifi, Osama Saadeldeen Ebrahim, Mahmoud Mohamed Metwally, Rowida Elmelegy, Diaa Moustafa Elbendary Elsawahly, Hisham Safa, Eman Nofal, Mohamed Elbermawy, Ahmed Abdelmotaleb Ghazy, Hisham Samih, Asmaa Abdelgelil, Sarah Abdelghany, Ahmed El Kholy, Metwally Aboraya, Fatma Elkady, Mahmoud Salma, Sarah Samy, Reem Fakher, Aya Aboarab, Ahmed Samir, Ahmed Sakr, Abdelrahman Haroun, Asmaa Abdel-Rahman Al-Aarag, Ahmed Elkholy, Sally Elshanwany, Esraa Ghanem, Ahmed Tammam, Ali Mohamed Hammad, Yousra El Shoura, Gehad El Ashal, Hosni Khairy, Sarah Antar, Sara Mehrez, Mahmoud Abdelshafy, Maha Gamal Mohamad Hamad, Mona Hosh, Emad Abdallah, Basma Magdy, Thuraya Alzayat, Elsayed Gamaly, Hossam Elfeki, Amany Abouzahra, Shereen Elsheikh, Fatimah I Elgendy, Fathia Abd El-Salam, Osama Seifelnasr, Mohamed Ammar, Athar Eysa, Aliaa Sadek, Aliaa Gamal Toeema, Aly Nasr, Mohamed Abuseif, Hagar Zidan, Sara Abd Elmageed Barakat, Nadin Elsayed, Yasmin Abd Elrasoul, Ahmed Elkelany, Mohamed Sabry Ammar, Mennat-Allah Mustafa, Yasmin Hegazy, Mohamed Etman, Samar Saad, Mahmoud Alrahawy, Ahmed Raslan, Mahmoud Morsi, Ahmed Rslan, Ahmed Sabry, Hager Elwakil, Heba Shaker, Yasmin Abd-Elrasoul, Hussein El-Kashef, Mohamed Shaalan, Areej Tarek, Ayman Elwan, Ahmed Ragab Nayel, Mostafa Seif, Doaa Emadeldin, Mohamed Ali Ghonaim, Ahmad Almallah, Ahmed Fouad, Eman Adel Sayma, Ahmad Elbatahgy, Angham Solaiman El-Ma'doul, Ahmed Mosad, Hager Tolba, Diaa Eldin Abdelazeem Amin Elsorogy, Hassan Ali Mostafa, Amira Atef Omar, Ola Sherief Abd El Hameed, Ahmed Lasheen, Yasser Abd El Salam, Ashraf Morsi, Mohammed Ismail, Hager Ahmed El-badawy, Mohamed A Amer, Ahmed Sabry El-Hamouly, Noura A Attallah, Omnia Mosalum, Ahmed Afandy, Ahmed Mokhtar, Alaa Abouelnasr, Sara Ayad, Ramdan Shaker, Rokia Sakr, Ramadan Shaker, Mahmoud Amreia, Soaad Elsobky, Mohamed Mustafa, Ahmed Abo El Magd, Abeer Marey, Amr Tarek Hafez, Mohamed F Zalabia, Mohamed Moamen Mohamed, Amr Fadel, Emad Ali Ahmed, Ahmad Ali, Mohammad Ghassan Alwafai, Abdullah Dwydar, Sara Kharsa, Ehab Mamdouh, Hatem El-Sheemy, Ibrahim AlYoussef, Abouelatta Khairy Aly, Ahmad Aldalaq, Ehab Alnawam, Dalia Alkhabbaz, Mahmoud Saad, Shady Hussein, Ahmed Abo Elazayem, Ahmed Meshref, Marwa Elashmawy, Mohammed Mousa, Ahmad Nashaat, Sara Ghanem, Zaynab M Elsayed, Aya Elwaey, Iman Elkadsh, Mariam Darweesh, Ahmed Mohameden, Mennaallah Hafez, Ahmed Badr, Assmaa Badwy, Mohamed Abd El Slam, Mohamed Elazoul, Safwat Al-Nahrawi, Lotfy Eldamaty, Fathee Nada, Mohamed Ameen, Aya Hagar, Mohamed Elsehimy, Mohammad Aboraya, Hossam Dawoud, Shorouk El Mesery, Abeer El Gendy, Ahmed Abdelkareem, Ahmed Safwan Marey, Mostafa Allam, Sherif Shehata, Khaled Abozeid, Marwa Elshobary, Ahmed Fahiem, Sameh Sarsik, Amel Hashish, Mohamed Zidan, Mohamed Hashish, Shaimaa Aql, Abdelaziz Osman Abdelaziz Elhendawy, Mohamed Husseini, Esraa Kasem, Ahmed Gheith, Yasmin Elfouly, Ahmed Ragab Soliman, Yasmein Ibrahim, Nesma Elfouly, Ahmed Fawzy, Ahmed Hassan, Mohammad Rashid, Abdallah Salah Elsherbiny, Basem Sieda, Nermin M Badwi, Mohammed Mustafa Hassan Mohammed, Osama Mohamed, Mohammad Abdulkhalek Habeeb, Mengistu Worku, Nichole Starr, Semay Desta, Sahlu Wondimu, Nebyou Seyoum Abebe, Efeson Thomas, Frehun Ayele Asele, Daniel Dabessa, Nebiyou Seyoum Abebe, Abebe Bekele Zerihun, Panu Mentula, Ari Leppaniemi, Ville Sallinen, Aurelien Scalabre, Fernanda Frade, Sabine Irtan, Vivien Graffeille, Elodie Gaignard, Quentin Alimi, Vivien Graffieille, Olivier Abbo, Sofia Mouttalib, Ourdia Bouali, Erik Hervieux, Yves Aigrain, Nathalie Botto, Alice Faure, Lucile Fievet, Nicoleta Panait, Emilie Eyssartier, Francoise Schmitt, Guillaume Podevin, Valentine Parent, Amandine Martin, Alexis Pierre Arnaud, Cecile Muller, Arnaud Bonnard, Matthieu Peycelon, Francis Abantanga, Kwaku Boakye-Yiadom, Mohammed Bukari, Frank Owusu, Joseph Awuku-Asabre, Lemuel Davies Bray, Dimitrios Lytras, Kyriakos Psarianos, Anastasia Bamicha, Eirini Kefalidi, Georgios Gemenetzis, Christos Dervenis, Nikolaos Gouvas, Christos Agalianos, Michail Kontos, Gregory Kouraklis, Dimitrios Karousos, Stylianos Germanos, Constantinos Marinos, Christos Anthoulakis, Nikolaos Nikoloudis, Nikolaos Mitroudis, Sergio Estupinian, Walter Forno, Jose Rene Arevalo Azmitia, Carla Cecilia Ramarez Cabrera, Romeo Guevara, Maria Aguilera, Napoleon Mendez, Cesar Augusto Azmitia Mendizabal, Pablo Ramazzini, Mario Contreras Urquizu, Fernando Tale, Rafael Soley, Emanuel Barrios, Emmanuel Barrios, Daniel Estuardo Marroquin Rodriguez, Carlos Ivan Perez Velasquez, Sara Maria Contreras Merida, Francisco Regalado, Mario Lopez, Miguel SiguantayAbstract
Background
Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide.
Methods
This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days.
Results
4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33–4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76–2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42–0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14–0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11–0.44) and SSI (OR 0.21 95% CI 0.09–0.45).
Conclusion
A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments.
Trial registration: NCT02179112.
