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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 

Original publication

DOI

10.1007/s00464-018-6064-9

Type

Journal article

Journal

Surg Endosc

Publication Date

08/2018

Volume

32

Pages

3450 - 3466

Keywords

Appendectomy, Appendicitis, Global surgery, Laparoscopic, Operative standards, Postoperative care, Postoperative complications, Surgical site infection, Adolescent, Adult, Aged, Aged, 80 and over, Appendectomy, Appendicitis, Child, Developed Countries, Developing Countries, Emergencies, Female, Follow-Up Studies, Humans, Laparoscopy, Male, Middle Aged, Postoperative Complications, Propensity Score, Prospective Studies, Risk Factors, Treatment Outcome, Young Adult