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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 (6·9 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 

Original publication

DOI

10.1002/bjs5.50138

Type

Journal article

Journal

BJS Open

Publication Date

06/2019

Volume

3

Pages

403 - 414

Keywords

Adult, Aged, Aged, 80 and over, Anastomosis, Surgical, Colorectal Neoplasms, Colostomy, Developed Countries, Developing Countries, Elective Surgical Procedures, Emergencies, Female, Global Health, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Prospective Studies