Management and Outcomes Following Surgery for Gastrointestinal Typhoid: An International, Prospective, Multicentre Cohort Study

Background Gastrointestinal perforation is the most serious complication of typhoid fever, with a high disease burden in low-income countries. Reliable, prospective, contemporary surgical outcome data are scarce in these settings. This study aimed to investigate surgical outcomes following surgery f...

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Published in:	World journal of surgery Vol. 42; no. 10; pp. 3179 - 3188
Main Authors:	Fitzgerald, J. Edward, Aguilera, Maria Lorena, Alexander, Philip, Al‐Saqqa, Sara W., Costas‐Chavarri, Ainhoa, Mihaljevic, Andre L., Morton, Dion, Adisa, Adewale O., Pinkney, Thomas, Poškus, Tomas, Rayne, Sarah, Smart, Neil, Hakim, Hafiz, Oosterkamp, Antje, Tabiri, Stephen, Bhat, Sriram, Reddy, Yella, Venugopal, Caranj, Jain, Pratik, Satoskar, Savni, Mohammad, Aminu, Anyanwu, Lofty‐John, Sheshe, Abdulrahman, Taiwo, Ogechukwu, Ibrahim, Muhammad Habib, Ogunyemi, Ayokunle, Oludara, Mobolaji, Oshodi, Olabode, Osuoji, Roland, Ajao, Akinlabi E., Odeyemi, Babatunde, Adeniran, James, Rashid, Anam, Yaseen, Tahir Muhammad, Arachchi, Prasad Pitigala, Senanayake, Wanigasekara Senanayake Mudiyanselage Kithsiri Janakantha, Sivaganesh, Sivasuriya, Ademuyiwa, Adesoji O., Djivoh, Fernande, Gbessi, Dansou Gaspard, Hodonou, Fred, Abantanga, Francis, Kyereh, Martin, Appiah, Eric Kofi, Dally, Charles, Dayie, Makafui, Etwire, Victor, Essoun, Samuel, Glover‐Addy, Hope, Ekow, Mattew, Avoka, Anthony, Barnabas, Gandau Naa, Davor, Anthony, Kwakyeafriyie, Prince, Akoto, Elliot, Ackom, Eric, Atkins, Ebenezer Takyi, Coompson, Christian Lari, Mohammed, Hussein, Parker, Robert, Chin, Pui Xin, Salleh, Afizah, Riswan, Nur Zulaika, Roslani, April Camilla, Taher, Mustafa Mohammed, Kosai, Nik Ritza, Sii, Samuel S. Y., Koay, Kean Leong, Henry, Fitjerald, Tan, Yee Wen, Tata, Mahadevan Deva, Yoganathan, Pigeneswaren, Ajao, Akinlabi, Lawal, Taiwo, Adebanjo, Ademola, Mendel, Henry, Bello, Bashir, Olajide, Thomas Olagboyega, Oshati, Oyindamola, Nwinee, Victor, Alakaloko, Felix, Bode, Chris, Faturoti, Olubukola, Onuoha, Clement, Ajai, Olalekan, Kache, Stephen, Ogunsua, Oluseyi, Adeyeye, Ademola, Shahzad, Noman, Butt, Muhammad Talha, Bani‐Sadar, Ahmad, Qureshi, Ahmad Uzair, Raza, Awais, Khan, Maryam Ali, Imoro, Osman, Wondoh, Paul, Sale, Danjuma, Tan, Choy Ling
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01-10-2018 Springer Nature B.V
Subjects:	Abdominal Surgery Adolescent Adult Cardiac Surgery Child Child, Preschool Children Cohort analysis Confidence intervals Female Fever Gastrointestinal Diseases - complications Gastrointestinal Diseases - surgery General Surgery Humans Infections International Cooperation Intestinal Perforation - etiology Intestine Logistic Models Male Medicine Medicine & Public Health Morbidity Mortality Odds Ratio Original Scientific Report Patients Perforation Poverty Prospective Studies Public Health Regression analysis Regression models Statistical analysis Surgery Surgical outcomes Surgical site infections Surgical Wound Infection - complications Thoracic Surgery Treatment Outcome Typhoid Typhoid Fever - complications Typhoid Fever - surgery Vascular Surgery Waterborne diseases
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Summary:	Background Gastrointestinal perforation is the most serious complication of typhoid fever, with a high disease burden in low-income countries. Reliable, prospective, contemporary surgical outcome data are scarce in these settings. This study aimed to investigate surgical outcomes following surgery for intestinal typhoid. Methods Two multicentre, international prospective cohort studies of consecutive patients undergoing surgery for gastrointestinal typhoid perforation were conducted. Outcomes were measured at 30 days and included mortality, surgical site infection, organ space infection and reintervention rate. Multilevel logistic regression models were used to adjust for clinically plausible explanatory variables. Effect estimates are expressed as odds ratios (ORs) alongside their corresponding 95% confidence intervals. Results A total of 88 patients across the GlobalSurg 1 and GlobalSurg 2 studies were included, from 11 countries. Children comprised 38.6% (34/88) of included patients. Most patients (87/88) had intestinal perforation. The 30-day mortality rate was 9.1% (8/88), which was higher in children (14.7 vs. 5.6%). Surgical site infection was common, at 67.0% (59/88). Organ site infection was common, with 10.2% of patients affected. An ASA grade of III and above was a strong predictor of 30-day post-operative mortality, at the univariable level and following adjustment for explanatory variables (OR 15.82, 95% CI 1.53–163.57, p = 0.021). Conclusions With high mortality and complication rates, outcomes from surgery for intestinal typhoid remain poor. Future studies in this area should focus on sustainable interventions which can reduce perioperative morbidity. At a policy level, improving these outcomes will require both surgical and public health system advances.
Bibliography:	https://doi.org/10.1007/s00268‐018‐4624‐8 Collaborating members are listed in the Acknowledgments. Department of Surgery, University for Development Studies, School of Medicine and Health Sciences and Tamale Teaching Hospital, Tamale, Ghana, e‐mail: kstephenba@yahoo.com Electronic supplementary material contains supplementary material, which is available to authorized users. Correspondence to: Stephen Tabiri The online version of this article ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0364-2313 1432-2323
DOI:	10.1007/s00268-018-4624-8