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Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

GlobalSurg Collaborative ; Thomas, Hannah S ; Weiser, Thomas G ; [weitere]

Oxford University Press (OUP) ; 2019

In: British Journal of Surgery Vol. 106, No. 2 ( 2019-01-08), p. e103-e112

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In: British Journal of Surgery, Oxford University Press (OUP), Vol. 106, No. 2 ( 2019-01-08), p. e103-e112

Kurzfassung: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P & lt; 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P & lt; 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9·4 (95 per cent c.i. −11·9 to −6·9) per cent; P & lt; 0·001), but the relationship was reversed in low-HDI countries (+12·1 (+7·0 to +17·3) per cent; P & lt; 0·001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0·60, 0·50 to 0·73; P & lt; 0·001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.

Materialart: Online-Ressource

ISSN: 0007-1323 , 1365-2168

URL: Article

DOI: 10.1002/bjs.11051

Sprache: Englisch

Verlag: Oxford University Press (OUP)

Publikationsdatum: 2019

ZDB Id: 2006309-X

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

GlobalSurg Collaborative ; Glasbey, James C ; Adisa, Adewale O ; [weitere]

Oxford University Press (OUP) ; 2019

In: BJS Open Vol. 3, No. 3 ( 2019-06), p. 403-414

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In: BJS Open, Oxford University Press (OUP), Vol. 3, No. 3 ( 2019-06), p. 403-414

Materialart: Online-Ressource

ISSN: 2474-9842 , 2474-9842

URL: Issue

URL: Article

DOI: 10.1002/bjs5.2019.3.issue-3

DOI: 10.1002/bjs5.50138

Sprache: Englisch

Verlag: Oxford University Press (OUP)

Publikationsdatum: 2019

ZDB Id: 2902033-5

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Global economic burden of unmet surgical need for appendicitis

Reuter, Anna ; Rogge, Lisa ; Monahan, Mark ; [weitere]

Oxford University Press (OUP) ; 2022

In: British Journal of Surgery Vol. 109, No. 10 ( 2022-09-09), p. 995-1003

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In: British Journal of Surgery, Oxford University Press (OUP), Vol. 109, No. 10 ( 2022-09-09), p. 995-1003

Kurzfassung: There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and $73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and $75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially.

Materialart: Online-Ressource

ISSN: 0007-1323 , 1365-2168

URL: Article

DOI: 10.1093/bjs/znac195

Sprache: Englisch

Verlag: Oxford University Press (OUP)

Publikationsdatum: 2022

ZDB Id: 2006309-X

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Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study

GlobalSurg Collaborative ; Drake, Thomas M. ; Camilleri-Brennan, Julian ; [weitere]

Springer Science and Business Media LLC ; 2018

In: Surgical Endoscopy Vol. 32, No. 8 ( 2018-08), p. 3450-3466

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In: Surgical Endoscopy, Springer Science and Business Media LLC, Vol. 32, No. 8 ( 2018-08), p. 3450-3466

Kurzfassung: 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.

Materialart: Online-Ressource

ISSN: 0930-2794 , 1432-2218

URL: Article

DOI: 10.1007/s00464-018-6064-9

Sprache: Englisch

Verlag: Springer Science and Business Media LLC

Publikationsdatum: 2018

ZDB Id: 1463171-4

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