Management and Outcomes Following Surgery for Gastrointestinal Typhoid: An International, Prospective, Multicentre Cohort Study
Authors:   GlobalSurg Collaborative, Anyomih Theophilus T. K. , Drake Thomas M. , Glasbey James , Fitzgerald J. Edward , Ots Riinu , Harrison Ewen M. , Tabiri Stephen , Bhangu Aneel , Ademuyiwa Adesoji O. , Aguilera Maria Lorena , Alexander Philip , Al‐Saqqa Sara W. , Borda‐Luque Giuliano , Costas‐Chavarri Ainhoa , Drake Thomas M. , Ntirenganya Faustin , Fitzgerald J. Edward , Fergusson Stuart J. , Glasbey James , Allen Ingabire J. C. , Ismaïl Lawani , Salem Hosni Khairy , Kojo Anyomih Theophilus Teddy , Lapitan Marie Carmela , Lilford Richard , Mihaljevic Andre L. , Morton Dion , Mutabazi Alphonse Zeta , Nepogodiev Dmitri , Adisa Adewale O. , Ots Riinu , Pata Francesco , Pinkney Thomas , Poškus Tomas , Qureshi Ahmad Uzair , la Medina Antonio Ramos‐De , Rayne Sarah , Shaw Catherine A. , Shu Sebastian , Spence Richard , Smart Neil , Tabiri Stephen , Harrison Ewen M. , Ademuyiwa A. O. , Tabiri S. , Manipal Cutting Edge , Mohan M. , Jeyakumar J. , Mitul Ashrarur Rahman , Mahmud Khalid , Hussain Margub , Hakim Hafiz , Kumar Tapan , Oosterkamp Antje , Abantanga Francis , Boakye‐Yiadom Kwaku , Bukari Mohammed , Owusu Frank , Awuku‐Asabre Joseph , Tabiri Stephen , Bray Lemuel Davies , Prasad S. S. , Kirishnan Anand , Gyanchandani Nidhi , Kumar Bylapudi Seshu , Rangarajan Muthukumaran , Bhat Sriram , Sreedharan Anjana , Kinnera S. V. , Reddy Yella , Venugopal Caranj , Kumar Sunil , Mittal Abhishek , Nadkarni Shravan , Lakshmi Harish Neelamraju , Malik Puneet , Limaye Neel , Pai Srinivas , Jain Pratik , Khajanchi Monty , Satoskar Savni , Satoskar Rajeev , Mahamood Abid Bin , Coomber Ross , Johnson Kenneth , Nowers Jennifer , Mohammad Aminu , Anyanwu Lofty‐John , Sheshe Abdulrahman , Adesina Alaba , Faturoti Olubukola , Taiwo Ogechukwu , Ibrahim Muhammad Habib , Nasir Abdulrasheed A. , Suleiman Siyaka Itopa , Adeniyi Adewale , Adesanya Opeoluwa , Adebanjo Ademola , Williams Omolara , Atobatele Kazeem , Ogunyemi Ayokunle , Oludara Mobolaji , Oshodi Olabode , Osuoji Roland , Ademuyiwa Adesoji , Lawal AbdulRazzaq Oluwagbemiga , Alakaloko Felix , Elebute Olumide , Osinowo Adedapo , Bode Christopher , Adesuyi Abidemi , Tade Adesoji , Adekoya Adeleke , Nwokoro Collins , Ayandipo Omobolaji O. , Lawal Taiwo Akeem , Ajao Akinlabi E. , Ali Samuel Sani , Odeyemi Babatunde , Olori Samson , Popoola Ademola , Adeyeye Ademola , Adeniran James , Bhopal Kamran Faisal , Iftikhar Zainab , Furqan Muhammad Mohsin , Nighat Bakhtiar , Jawaid Masood , Khalique Abdul , Zil‐E‐Ali Ahsan , Rashid Anam , Dharamshi Hasnain Abbas , Naqvi Tahira , Faraz Ahmad , Anwar Abdul Wahid , Yaseen Tahir Muhammad , Shamsi Ghina Shamim , Shamsi Ghina , Yaseen Tahir , Anwer Wahid , Arachchi Prasad Pitigala , Senanayake Wanigasekara Senanayake Mudiyanselage Kithsiri Janakantha , Arachchige Lalith Asanka Jayasooriya Jayasooriya , Sivaganesh Sivasuriya , Samaraweera Dulan Irusha , Thanusan Vimalakanthan , Ismaïl Lawani , Tabiri Stephen , Tew Yong Yong , Ademuyiwa Adesoji O. , Gala Tanzeela , Djivoh Fernande , Ismaïl Lawani , Dossou Francis , Seto Djifid Morel , Gbessi Dansou Gaspard , Noukpozounkou Bruno , Souaibou Yacoubou Imorou , Keke Kpèmahouton René , Hodonou Fred , Ahounou Ernest Yemalin Stephane , Alihonou Thierry , Dénakpo Max , Ahlonsou Germain , Tabiri Stephen , Kojo Anyomih Theophilus Teddy , Bandoh Dickson , Abantanga Francis , Kyereh Martin , Asumah Hamza , Appiah Eric Kofi , Wondoh Paul , Gyedu Adam , Dally Charles , Agbedinu Kwabena , Amoah Michael , Yifieyeh Abiboye , Owusu Frank , Amoako‐Boateng Mabel , Dayie Makafui , Hagan Richmond , Debrah Sam , Ohene‐Yeboah Micheal , Clegg‐Lampety Joe‐Nat , Etwire Victor , Dakubo Jonathan , Essoun Samuel , Bonney William , Glover‐Addy Hope , Osei‐Nketiah Samuel , Amoako Joachim , Adu‐Aryee Niiarmah , Appeadu‐Mensah William , Bediako‐Bowan Antoinette , Dedey Florence , Ekow Mattew , Akatibo Emmanuel , Yakubu Musah , Kordorwu Hope Edem Kofi , Asare‐Bediako Kwasi , Tackie Enoch , Aaniana Kenneth , Acquah Emmanuel , Opoku‐Agyeman Richard , Avoka Anthony , Kusi Kwasi , Maison Kwame , Gyamfi Frank Enoch , Barnabas Gandau Naa , Abdul‐Latif Saiba , Amoako Philip Taah , Davor Anthony , Dassah Victor , Dagoe Enoch , Kwakyeafriyie Prince , Akoto Elliot , Ackom Eric , Mensah Ekow , Atkins Ebenezer Takyi , Coompson Christian Lari , Yusufali Taha , Mohammed Hussein , Lando Justus , Parker Robert , Ndegwa Wairimu , Chai Feng Yih , Asilah Siti Mohd Desa , Syibrah Khuzaimah Zahid , Chin Pui Xin , Salleh Afizah , Riswan Nur Zulaika , Roslani April Camilla , Chong Hoong‐Yin , Aziz Nora Abdul , Poh Keat‐Seong , Chai Chu‐Ann , Kumar Sandip , Taher Mustafa Mohammed , Kosai Nik Ritza , Aziz Dayang Nita Abdul , Rajan Reynu , Julaihi Rokayah , Jethwani Durvesh Lacthman , Yahaya Muhammad Taqiyuddin , Abdullah Nik Azim Nik , Mathew Susan Wndy , Chung Kuet Jun , Nirumal Milaksh Kumar , Goh Ern Tze R. , Ali Syed Abdul Wahhab Eusoffee Wan , Gan Yiing Yee , Ting Jesse Ron Swire , Sii Samuel S. Y. , Koay Kean Leong , Tan Yi Koon , Cheah Alvin Ee Zhiun , Wong Chui Yee , Mat Tuan Nur’Azmah Tuan , Chow Crystal Yern Nee , Har Prisca A. L. , Der Yishan , Tew Yong Yong , Henry Fitjerald , Low Xinwei , Neo Ya Theng , Heng Hian Ee , Kong Shu Ning , Gan Cheewei , Mok Yi Ting , Tan Yee Wen , Palayan Kandasami , Tata Mahadevan Deva , Cheong Yih Jeng , Gunaseelan Kuhaendran , Nasir Wan Nurul ‘Ain Wan Mohd , Yoganathan Pigeneswaren , Lee Eu Xian , Saw Jian Er , Yeang Li Jing , Koh Pei Ying , Lim Shyang Yee , Teo Shuang Yi , Ajao Akinlabi , Ayandipo Omobolaji , Lawal Taiwo , Abdurrazzaaq Abdussemiu , Alada Muslimat , Nasir Abdulrasheed , Adeniran James , Habeeb Olufemi , Popoola Ademola , Adeyeye Ademola , Adebanjo Ademola , Adesanya Opeoluwa , Adeniyi Adewale , Mendel Henry , Bello Bashir , Muktar Umar , Osinowo Adedapo , Olajide Thomas Olagboyega , Oshati Oyindamola , Ihediwa George , Adenekan Babajide , Nwinee Victor , Alakaloko Felix , Ademuyiwa Adesoji , Elebute Olumide , Lawal Abdulrazzaq , Bode Chris , Olugbemi Mojolaoluwa , Adesina Alaba , Faturoti Olubukola , Odutola Oluwatomi , Adebola Oluwaseyi , Onuoha Clement , Taiwo Ogechukwu , Williams Omolara , Balogun Fatai , Ajai Olalekan , Oludara Mobolaji , Njokanma Iloba , Osuoji Roland , Kache Stephen , Ajah Jonathan , Makama Jerry , Adamu Ahmed , Baba Suleiman , Aliyu Mohammad , Aliyu Shamsudeen , Ukwenya Yahaya , Aliyu Halima , Sholadoye Tunde , Daniyan Muhammad , Ogunsua Oluseyi , Anyanwu Lofty‐John , Sheshe Abdurrahaman , Mohammad Aminu , Olori Samson , Mshelbwala Philip , Odeyemi Babatunde , Samson Garba , Timothy Oyediran Kehinde , Samuel Sani Ali , Ajiboye Anthony , Adeyeye Ademola , Amole Isaac , Abiola Olajide , Olaolorun Akin , Nadeem Najwa , Saqlain Muhammad , Abbasy Jibran , Alvi Abdul Rehman , Gala Tanzeela , Shahzad Noman , Bhopal Kamran Faisal , Iftikhar Zainab , Butt Muhammad Talha , Razi Syed Asaat ul , Ahmed Asdaq , Niazi Ali Khan , Raza Ibrahim , Baluch Fatima , Raza Ahmed , Bani‐Sadar Ahmad , Qureshi Ahmad Uzair , Adil Muhammad , Raza Awais , Javaid Mahnoor , Waqar Muhammad , Khan Maryam Ali , Arshad Mohammad Mohsin , Amjad Mohammadasim , Allen Ingabire J. C. , Mutabazi Alphonse Zeta , Uzabumwana Norbert , Duhoranenayo Dieudonne , Clegg‐Lamptey Joe‐Nat , Imoro Osman , Abem Owusu Emmanuel , Wondoh Paul , Sale Danjuma , Abdullahi Lawal , Osagie Olabisi , Faboya Omolara , Fatuga Adedeji , Taiwo Agboola , Nwabuoku Emeka , Khan Zain Ali , Rickard Jennifer , Tan Choy Ling , Siaw Jia Yng , Yam Sir Young , Wilson Ling , Aziz Mohamed Rezal Abdul 
Published: May 2018

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.