Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study
Authors:   GlobalSurg Collaborative, Drake Thomas M. , Camilleri-Brennan Julian , Tabiri Stephen , Fergusson Stuart J. , Spence Richard , Fitzgerald J. Edward F. , Bhangu Aneel , Harrison Ewen M. , Ademuyiwa Adesoji O. , Fergusson Stuart , Glasbey James C. , Khatri Chetan , Mohan Midhun , Nepogodiev Dmitri , Søreide Kjetil , Gobin Neel , Freitas Ana Vega , Hall Nigel , Kim Sung-Hee , Negida Ahmed , Jaffry Zahra , Chapman Stephen J. , Arnaud Alexis P. , Recinos Gustavo , Manipal Cutting Edge , Amandito Radhian , Shawki Marwan , Hanrahan Michael , Pata Francesco , Zilinskas Justas , Roslani April Camilla , Goh Cheng Chun , Irwin Gareth , Shu Sebastian , Luque Laura , Shiwani Hunain , Altamimi Afnan , Alsaggaf Mohammed Ubaid , Rayne Sarah , Jeyakumar Jenifa , Cengiz Yucel , Raptis Dmitri A. , Fermani Claudio , Balmaceda Ruben , Modolo Maria Marta , Macdermid Ewan , Chenn Roxanne , Yong Cheryl Ou , Edye Michael , Jarmin Martin , D’amours Scott K. , Iyer Dushyant , Youssef Daniel , Phillips Nicholas , Brown Jason , George Robert , Koh Cherry , Warren Oliver , Hanley Isaac , Dickfos Marilla , Nawara Clemens , Öfner Dietmar , Primavesi Florian , Mitul Ashrarur Rahman , Mahmud Khalid , Hussain Margub , Hakim Hafiz , Kumar Tapan , Oosterkamp Antje , Assouto Pamphile A. , Lawani Ismail , Souaibou Yacoubou Imorou , Tun Aung Kyaw , Chong Chean Leung , Devadasar Giridhar H. , Qadir Muhammad Rashid Minhas , Aung Kyaw Phyo , Yeo Lee Shi , Castillo Vanessa Dina Palomino , Munhoz Monique Moron , Moreira Gisele , De Castro Segundo Luiz Carlos Barros , Ferreira Salim Anderson Khouri , Careta Maíra Cassa , Kim Stella Binna , De Sousa Alexandre Venancio , Cury Alyne Daltri Lazzarini , Miguel Gustavo Peixoto Soares , De Freitas Ana Vega Carreiro , Silvestre Barbara Pereira , Vianna Julia Guasti Pinto , Felipe Carolina Oliveira , Laufer Luis Alberto Valente , Altoe Fernanda , Da Silva Luana Ayres , Pimenta Marina Luiza , Giuriato Thiago Fernandes , Morais Paulo Alves Bezerra , Luiz Jessica Souza , Araujo Rafael , Menegussi Juliana , Leal Marisa , de Lima Caio Vinícius Barroso , Tatagiba Luiza Sarmento , Leal Antônio , dos Santos Diogo Vinicius , Fraga Gustavo Pereira , Simoes Romeo Lages , Stock Simon , Nigo Samuel , Kabba Juana , Ngwa Tagang Ebogo , Brown James , King Sebastian , Zani Augusto , Azzie Georges , Firdouse Mohammed , Kushwaha Sameer , Agarwal Arnav , Bailey Karen , Cameron Brian , Livingston Michael , Horobjowsky Alexandre , Deckelbaum Dan L. , Razek Tarek , Marinkovic Boris , Grasset Eugenio , D’aguzan Nicole , Jimenez Julio , Macchiavello Roberto , Zhang Zhongtao , Guo Wei , Oh Junyeong , Zheng Fei , Montes Irene , Sierra Sebastian , Mendez Manuela , Villegas Maria Isabel , Arango Maria Clara Mendoza , Mendoza Ivan , Aristizã¡bal Fred Alexander Naranjo , Botero Jaime Andres Montoya , Riaza Victor Manuel Quintero , Restrepo Jakeline , Morales Carlos , Cruz Herman , Munera Alejandro , Karlo Robert , Domini Edgar , Mihanovic Jakov , Radic Mihael , Zamarin Kresimir , Pezelj Nikica , Hache-Marliere Manuel , Lemaire Sylvia Batista , Rivas Ruben , Khyrallh Ahmed , Hassan Ahamed , Shimy Gamal , Baky Fahmy Mohamed A. , Nabawi Ayman , Elfil Mohamed , Ghoneem Mohamed , Gohar Muhammad El-Saied Ahmad Muhammad , Asal Mohamed , Abdelkader Mostafa , Gomah Mahmoud , Rashwan Hayssam , Karkeet Mohamed , Gomaa Ahmed , Hasan Amr , Elgebaly Ahmed , Saleh Omar , Fattah Ahmad Abdel , Gouda Abdullah , Elshafay Abd Elrahman , Gharib Abdalla , Menshawy Ahmed , Hanafy Mohammed , Al-Mallah Abdullah , Abdulgawad Mahmoud , Baheeg Mohamad , Alhendy Mohammed , AbdelFattah Ibrahim , Kenibar Abdalla , Osman Omar , Gemeah Mostafa , Mohammed Ahmed , Adel Abdalrahman , Mohammed Abdelrahman , Sayed Abdelrahman , Abozaid Mohamed , Kotb Ahmed Hafez El-Badri , Ata Ali Amin Ahmed , Nasr Mohammed , Alkammash Abdelrahman , Saeed Mohammed , Hamid Nader Abd El , Attia Attia Mohamed , Galeel Ahmed Abd El , Elbanby Eslam , El-Dien Khalid Salah , Hantour Usama , Alahmady Omar , Mansour Billal , Elkorashy Amr Muhammad , Taha Emad Mohamed Saeed , Lasheen Kholod Tarek , Elkolaly Salma Said , Abdel-Wahab Nehal Yosri Elsayed , Abozyed Mahmoud Ahmed Fathi , Adel Ahmed , Saeed Ahmed Moustafa , Sayed Gehad Samir El , Youssif Jehad Hassan , Ahmed Soliman Magdy , El-Shahat Nermeen Soubhy , Khedr Abd El-Rahman Hegazy , Elsebaaye Abdelrhman Osama , Elzayat Mohamed , Abdelraheim Mohamed , Elzayat Ibrahim , Warda Mahmoud , Deen Khaled Naser El , Elnemr Abdelrhman Essam , Salah Omar , Abbas Mohamed , Rashad Mona , Elzayyat Ibrahim , Hemeda Dalia , Tawfik Gehad , Salama Mai , Khaled Hazem , Seisa Mohamed , Elshaer Kareem , Hussein Abdelfatah , Elkhadrawi Mahmoud , Afifi Ahmed Mohamed , Ebrahim Osama Saadeldeen , Metwally Mahmoud Mohamed , Elmelegy Rowida , Elsawahly Diaa Moustafa Elbendary , Safa Hisham , Nofal Eman , Elbermawy Mohamed , Ghazy Ahmed Abdelmotaleb , Samih Hisham , Abdelgelil Asmaa , Abdelghany Sarah , Kholy Ahmed El , Aboraya Metwally , Elkady Fatma , Salma Mahmoud , Samy Sarah , Fakher Reem , Aboarab Aya , Samir Ahmed , Sakr Ahmed , Haroun Abdelrahman , Al-Aarag Asmaa Abdel-Rahman , Elkholy Ahmed , Elshanwany Sally , Ghanem Esraa , Tammam Ahmed , Hammad Ali Mohamed , Shoura Yousra El , Ashal Gehad El , Khairy Hosni , Antar Sarah , Mehrez Sara , Abdelshafy Mahmoud , Hamad Maha Gamal Mohamad , Hosh Mona , Abdallah Emad , Magdy Basma , Alzayat Thuraya , Gamaly Elsayed , Elfeki Hossam , Abouzahra Amany , Elsheikh Shereen , Elgendy Fatimah I. , El-Salam Fathia Abd , Seifelnasr Osama , Ammar Mohamed , Eysa Athar , Sadek Aliaa , Toeema Aliaa Gamal , Nasr Aly , Abuseif Mohamed , Zidan Hagar , Barakat Sara Abd Elmageed , Elsayed Nadin , Elrasoul Yasmin Abd , Elkelany Ahmed , Ammar Mohamed Sabry , Mustafa Mennat-Allah , Hegazy Yasmin , Etman Mohamed , Saad Samar , Alrahawy Mahmoud , Raslan Ahmed , Morsi Mahmoud , Rslan Ahmed , Sabry Ahmed , Elwakil Hager , Shaker Heba , Abd-Elrasoul Yasmin , El-Kashef Hussein , Shaalan Mohamed , Tarek Areej , Elwan Ayman , Nayel Ahmed Ragab , Seif Mostafa , Emadeldin Doaa , Ghonaim Mohamed Ali , Almallah Ahmad , Fouad Ahmed , Sayma Eman Adel , Elbatahgy Ahmad , El-Ma’doul Angham Solaiman , Mosad Ahmed , Tolba Hager , Elsorogy Diaa Eldin Abdelazeem Amin , Mostafa Hassan Ali , Omar Amira Atef , Hameed Ola Sherief Abd El , Lasheen Ahmed , Salam Yasser Abd El , Morsi Ashraf , Ismail Mohammed , El-badawy Hager Ahmed , Amer Mohamed A. , El-Hamouly Ahmed Sabry , Attallah Noura A. , Mosalum Omnia , Afandy Ahmed , Mokhtar Ahmed , Abouelnasr Alaa , Ayad Sara , Shaker Ramdan , Sakr Rokia , Shaker Ramadan , Amreia Mahmoud , Elsobky Soaad , Mustafa Mohamed , Magd Ahmed Abo El , Marey Abeer , Hafez Amr Tarek , Zalabia Mohamed F. , Mohamed Mohamed Moamen , Fadel Amr , Ahmed Emad Ali , Ali Ahmad , Alwafai Mohammad Ghassan , Dwydar Abdullah , Kharsa Sara , Mamdouh Ehab , El-Sheemy Hatem , AlYoussef Ibrahim , Aly Abouelatta Khairy , Aldalaq Ahmad , Alnawam Ehab , Alkhabbaz Dalia , Saad Mahmoud , Hussein Shady , Elazayem Ahmed Abo , Meshref Ahmed , Elashmawy Marwa , Mousa Mohammed , Nashaat Ahmad , Ghanem Sara , Elsayed Zaynab M. , Elwaey Aya , Elkadsh Iman , Darweesh Mariam , Mohameden Ahmed , Hafez Mennaallah , Badr Ahmed , Badwy Assmaa , Slam Mohamed Abd El , Elazoul Mohamed , Al-Nahrawi Safwat , Eldamaty Lotfy , Nada Fathee , Ameen Mohamed , Hagar Aya , Elsehimy Mohamed , Aboraya Mohammad , Dawoud Hossam , Mesery Shorouk El , Gendy Abeer El , Abdelkareem Ahmed , Marey Ahmed Safwan , Allam Mostafa , Shehata Sherif , Abozeid Khaled , Elshobary Marwa , Fahiem Ahmed , Sarsik Sameh , Hashish Amel , Zidan Mohamed , Hashish Mohamed , Aql Shaimaa , Elhendawy Abdelaziz Osman Abdelaziz , Husseini Mohamed , Kasem Esraa , Gheith Ahmed , Elfouly Yasmin , Soliman Ahmed Ragab , Ibrahim Yasmein , Elfouly Nesma , Fawzy Ahmed , Hassan Ahmed , Rashid Mohammad , Elsherbiny Abdallah Salah , Sieda Basem , Badwi Nermin M. , Mohammed Mohammed Mustafa Hassan , Mohamed Osama , Habeeb Mohammad Abdulkhalek , Worku Mengistu , Starr Nichole , Desta Semay , Wondimu Sahlu , Abebe Nebyou Seyoum , Thomas Efeson , Asele Frehun Ayele , Dabessa Daniel , Abebe Nebiyou Seyoum , Zerihun Abebe Bekele , Mentula Panu , Leppäniemi Ari , Sallinen Ville , Scalabre Aurelien , Frade Fernanda , Irtan Sabine , Graffeille Vivien , Gaignard Elodie , Alimi Quentin , Graffieille Vivien , Abbo Olivier , Mouttalib Sofia , Bouali Ourdia , Hervieux Erik , Aigrain Yves , Botto Nathalie , Faure Alice , Fievet Lucile , Panait Nicoleta , Eyssartier Emilie , Schmitt Francoise , Podevin Guillaume , Parent Valentine , Martin Amandine , Arnaud Alexis Pierre , Muller Cecile , Bonnard Arnaud , Peycelon Matthieu , Abantanga Francis , Boakye-Yiadom Kwaku , Bukari Mohammed , Owusu Frank , Awuku-Asabre Joseph , Bray Lemuel Davies , Lytras Dimitrios , Psarianos Kyriakos , Bamicha Anastasia , Kefalidi Eirini , Gemenetzis Georgios , Dervenis Christos , Gouvas Nikolaos , Agalianos Christos , Kontos Michail , Kouraklis Gregory , Karousos Dimitrios , Germanos Stylianos , Marinos Constantinos , Anthoulakis Christos , Nikoloudis Nikolaos , Mitroudis Nikolaos , Estupinian Sergio , Forno Walter , Azmitia José René Arévalo , Cabrera Carla Cecilia Ramã-rez , Guevara Romeo , Aguilera Maria , Mendez Napoleon , Mendizabal Cesar Augusto Azmitia , Ramazzini Pablo , Urquizu Mario Contreras , Tale Fernando , Soley Rafael , Barrios Emanuel , Barrios Emmanuel , Rodríguez Daniel Estuardo Marroquín , Velásquez Carlos Iván Pérez , Mérida Sara María Contreras , Regalado Francisco , Lopez Mario , Siguantay Miguel , Lam Fong Yee , Szeto Kylie Joan-yi , Szeto Charing Cheuk Ling , Li Wing Sum , Li Kieran Ka Kei , Leung Man Fung , Mak Tony , Ng Simon , 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 , Sutanto Eldaa Prisca Refianti , Soeselo Daniel Ardian , Tedjaatmadja Chintya , Rahmawati Fitriana Nur , Mayasari Maria , Al-Hasani Ruqaya Kadhim Mohammed Jawad , Al-Hameedi Hasan Ismael Ibraheem , Ibraheem Hasan Ismael , Al-Azraqi Israa Abdullah Aziz , Sabeeh Lubna , Kamil Rahma , Telfah Muwaffaq Mezeil , Rasendran Amoudtha , Sheehan Jacqueline , Kerley Robert , Normile Caoimhe , Gilbert Richard William , Song Jiheon , Dablouk Mohamed , Mauro Linnea , Dablouk Mohammed Osman , Kielty Paul , Marks Eleanor , Gosling Simon , Mccarthy Michelle , Mirghani Diya , Naqvi Syed Altaf , Wong Chee Siong , Chung Siyi , D’cruz Reuban , Cahill Ronan , Gosling Simon George , Fahy Ciara , Cadogan Diana Duarte , Powell Anna , Gilbert Richard , Clifford Caroline , Driscoll Aoife , Paul Stassen , Lee Chris , Bowe Ross , Hutch William , Mohan Helen , O’neill Maeve , Mealy Kenneth , Danelli Piergiorgio , Bondurri Andrea , Maffioli Anna , Pasini Mario , Pata Giacomo , Roncali Stefano , Silvani Paolo , Carlucci Michele , Faccincani Roberto , Bonavina Luigi , Macchitella Yuri , Ceriani Chiara , Tugnoli Gregorio , Di Saverio Salomone , Khattab Khaled , Paludi Miguel Angel , Pata Domenica , Cloro Luigi Maria , Allegri Andrea , Ansaloni Luca , Coccolini Federico , Veronese Ezio , Bortolasi Luca , Hasheminia Alireza , Nastri Giacomo , Canto Massimiliano Dal , Cucumazzo Stefano , Benevento Angelo , Tessera Gaetano , Grandinetti Pier Paolo , Maniscalco Alessio , Lamanna Giovanni Luca , Turati Luca , Sgroi Giovanni , Rausa Emanuele , Villa Roberta , Monteleone Michela , Merlini David , Grassi Veronica , Cirocchi Roberto , Cacurri Alban , Waleed Hamza , Diab Ahmed , Elzowawi Fathi , Jokubauskas Mantas , Varkalys Karolis , Venskutonis Donatas , Pranevicius Robertas , Ambrozeviciute Viktorija , Juciute Simona , Skardžiukaitė Austė , Bradulskis Saulius , Urbanavicius Linas , Austraite Aiste , Riauka Romualdas , Dambrauskas Zilvinas , Karumnas Paulius , Urniezius Zigmantas , Zilinskiene Reda , Rudzenskaite Anele , Usaityte Ausrine , Montrimaite Margarita , Kaselis Nerijus , Strazdas Andrius , Jokubonis Kristijonas , Maceviciute Kornelija , Beisa Virgilijus , Poskus Tomas , Strupas Kestutis , Laugzemys Erikas , Kolosov Andrej , Jotautas Valdemaras , Rakita Ignas , Mikalauskas Saulius , Kazanavicius Darius , Rackauskas Rokas , Rakauskas Ritauras , Preckailaite Egle , Coomber Ross , Johnson Kenneth , Nowers Jennifer , Periasammy Dineshwary , Salleh Afizah , Das Andre , Tze Reuben Goh Ern , Kumar Milaksh Nirumal , Abdullah Nik Azim Nik , Kosai Nik Ritza , Taher Mustafa , Rajan Reynu , Chong Hoong Yin , Agius Marija , Borg Elaine , Bezzina Maureen , Bugeja Roberta , Vella-Baldacchino Martinique , Spina Andrew , Psaila Josephine , Francois-Coridon Helene , Tolg Cecilia , Colombani Jean-Francois , Diaz-Zorrilla Carmina , La Medina Antonio Ramos-De , Gonzalez Samantha Corro-Diaz , Jacobe Mário , Mapasse Domingos , Snyder Elizabeth , Oumer Ramadan , Osman Mohammed , 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 , Osuoji Roland , Atobatele Kazeem , Ogunyemi Ayokunle , Williams Omolara , Oludara Mobolaji , Oshodi Olabode , 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 , Lossius William J. , Havemann Ingemar , Thorsen Kenneth , Narvestad Jon Kristian , Soreide Kjetil , Wold Trude Beate , Nymo Linn , Elsiddig Mohammed , Dar Manzoor , 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 , Decoud Horacio Paredes , Aguilera Omar , Alvarez Ismael Isaac Zelada , Delgado Juan Marcelo , Vega Gustavo Miguel Machain , Lohse Helmut Alfredo Segovia , Aguilar Wendy Leslie Messa , Chiong Jose Antonio Cabala , Bautista Ana Cecilia Manchego , Huaman Eduardo , Zegarra Sergio , Camacho Rony , Celis Jose María Vergara , Pozo Diego Alonso Romani , Hamasaki José , Temoche Edilberto , Herrera-Matta Jaime , Torres Carla Pierina García , Barreda Luis Miguel Alvarez , Ojeda Ronald Renato Barrionuevo , Garaycochea Octavio , Mollo Melanie Castro , De Fã Tima Linares Delgado Mitchelle Solange , Fujii Francisco , Durand Susana Yrma Aranzabal , Basto Carlos Alejandro Arroyo , Rojas Nelson Manuel Urbina , Yip Sebastian Bernardo Shu , Vergara Ana Lucia Contreras , Moran Andrea Echevarria Rosas , Luque Giuliano Borda , Castro Manuel Rodriguez , Jaramillo Ramon Alvarado , Sila George Manrique , Lopez Crislee Elizabeth , De Leon Mardelangel Zapata Ponze , Machaca Massiell , Huaraya Ronald Coasaca , Arenas Andy , López Crislee , Puma Clara Milagros Herrera , Pino Wilfredo , Hinojosa Christian , De Leon Melanie Zapata Ponze , Limache Susan , Sila George Manrrique , Rodriguez Layza-Alejandra Mercado , Melo Renato , Costa-Maia Jose , Muralha Nuno , Sauvat Frederique , Dan Ionasc , Hogea Mircea , Eduard Pandi , Bratu Razvan-Matei , Beuran Mircea , Diaconescu Ionut-Bogdan , Martian Bogdan-Valeriu , Iordache Florin-Mihail , Vartic Mihaela , Vida Lucian Corneliu , Muntean Liviu Iuliu , Mironescu Aurel Sandu , Nsengimana Vizir Jean Paul , Niragire Alice , De La Croix Allen Ingabire Jean , Niyirera Eugene , Zanini Nicola , Jovine Elio , Landolfo Giovanni , Alomar Ibrahim N. , Alnuqaydan Saleh A. , Altwigry Abdulrahman M. , Othman Moayad , Osman Nohad , Alqahtani Enas , Alzahrani Mohammed , Alyami Rifan , Aljohani Emad , Alhabli Ibrahim , Mikwar Zaher , Almuallem Sultan , Nawawi Abrar , Bakhaidar Mohamad , Maghrabi Ashraf A. , Alsaggaf Mohammed , Aljiffry Murad , Altaf Abdulmalik , Khoja Ahmad , Habeebullah Alaa , Akeel Nouf , Ghandora Nashat , Almoflihi Abdullah , Huwait Abdulmalik , Al-shammari Abeer , Al-Mousa Mashael , Alghamdi Masood , Adham Walid , Albeladi Bandar , Alfarsi Muayad Ahmed , Mahdi Atif , Awwad Saad Al , Nouh Thamer , Hassanain Mazen , Aldhafeeri Salman , Sadig Nawal , Algohary Osama , Aledrisy Mohannad , Gudal Ahmad , Alrifaie Ahmad , AlRowais Mohammed , Althwainy Amani , Shabkah Alaa , Alamoudi Uthman , Alrajraji Mawaddah , Alghamdi Basim , Aljohani Saud , Daqeeq Abdullah , Al-Faifi Jubran J. , Jennings Vicky , Ngayu Nyawira , Moore Rachel , Kong Victor , Kretzmann Hayden , Connor Katie , Nel Daniel , Sampson Colleen , Panieri Eugenio , Sishuba Nosisa , Tun Myint , Mphatsoe Albert Mohale , Carreira Jo-Anne , Teasdale Ella , Wagener Mark , Botes Stefan , Du Plessis Danelo , Fernandez-Bueno Fernando , Aguilar-Jimenez Jose , Garcia-Marin Jose Andres , García Lorena Solar , Florez Luis Joaquín García , Pacheco Rubén Darío Arias , Pagnozzi Janet , Quezada Jimy Harold Jara , Rodicio Jose Luis , Minguez German , Rodríguez-Uría Raquel , Ugalde Paul , Lopez-Arevalo Camilo , Barneo Luis , Stuva Jessica Patricia Gonzales , Ortega-Vazquez Irene , Rodriguez Lorena , Herrera Norberto , Arachchi Prasad Pitigala , Senanayake Wanigasekara Senanayake Mudiyansela , Arachchige Lalith Asanka Jayasooriya Jayasoori , Sivaganesh Sivasuriya , Samaraweera Dulan Irusha , Thanusan Vimalakanthan , Musa Ahmed Elgaili Khalid , Balila Reem Mohammed Hassan , Mohamed Mohamed Awad Elkarim Hamad , Ali Hussein , Elabdin Hagir Zain , Hassan Alaa , Mahdi Sefeldin , Ahmed Hala , Idris Sahar Abdoun Ishag , Elsayed Makki , Elsayed Mohammed , Mahmoud Mohamed , Boijsen Magnus , Lundgren Per-Olof , Gustafsson Ulf , Kiasat Ali , Wogensen Fredrik , Jurdell Emma , Thorell Anders , Thorarinsdottir Hildur , Utter Maria , Sundstrom Sami Martin , Wredberg Cecilia , Kjellin Ann , Nyberg Johanna , Frisk Bjorn , Sund Malin , Andersson Linda , Gunnarsson Ulf , Cengiz Yücel , Ahlqvist Sandra , Björklund Ida , Royson Hanna , Weber Per , Pahlsson Hans-Ivar , Borin Eva , Hjertberg Maria , Schmid Roger , Schivo Debora , Despotidis Vasileios , Breitenstein Stefan , Staerkle Ralph F. , Schadde Erik , Deichsel Fabian , Gerosa Alexandra , Nocito Antonio , Raptis Dimitri Aristotle , Mijuskovic Barbara , Zuber Markus , Eisner Lukas , Kruspi Swantje , Reinisch Katharina Beate , Schoewe Christin , Novak Allan , Palma Adrian F. , Teufelberger Gerfried , Kimaro Msafiri , King Rachel , Balkan Ali Zeynel Abidin , Gumar Mehmet , Yavuz Mehmet Ali , Karabacak Ufuk , Lap Gokhan , Ozkan Bahar Busra , Karakahya Murat , Adams Ryan , Morton Robert , Henderson Liam , Gratton Ruth , Clement Keiran David , Chang Kate Yu-Ching , Mcnish David , Mcintosh Ryan , Milligan William , Skelly Brendan , Anderson-Knight Hannah , Lawther Roger , Onimowo Jemina , Shatkar Veereanna , Tharmalingam Shivanee , Woin Evelina , Fautz Tessa , Ziff Oliver , Dindyal Shiva , Arman Sam , Talukder Shagorika , Gadhvi Vijay , Chew Luen Shaun , Heath Jonathan , Blencowe Natalie , Hallam Sally , Gash Katherine , Mannu Gurdeep Singh , Zachariades Dimitris-Christos , Snaith Ailsa Claire , Hettiarachchi Thusitha Sampath , Nesaratnam Arjun , Wheeler James , McCullagh Darragh , Clements Joshua Michael , Khan Ata , Koumpa Foteini , Neophytou Christina , Roth Jessica , Soon Wai Cheong , Deputy Mohammed , Ahmed Ahmed , Ashton Annelisse , Vincent Joe , Almy Jack , Khan Taufiq , Allen John Lee Y. , Mcintyre Charlotte Jane , Marshall Dominic Charles , Sykes Mark , Behar Nebil , Jordan Harriet , Rajjoub Yaseen , Sherman Thomas , White Timothy , Watts Anna , Ardley Rohan , Arulampalam Tan , Shah Apar , Brown Damien , Blower Emma , Sutton Paul , Gasteratos Konstantinos , Vimalachandran Dale , Magee Cathy , Mcguigan Andrew , Mcaleer Stephen , Morgan Clare , Braungart Sarah , Lafferty Kirsten , Labib Peter , Tanase Andrei , Mangan Clodagh , Reza Lillian , Woodward Helen , Gouldthorpe Craig , Turner Megan , Wild Jonathan R. L. , Malik Tom A. M. , Proctor Victoria K. , Hewage Kalon , Davies James , Dubois Andre , Sarwary Sayed , Zardab Ali , Grant Alan , Mcintyre Robert , Mogan Yogendra Praveen , Ho Weiguang , Chong Bryon Frankie Hon Khi , Tewari Shirish , Humm Gemma , Farinella Eriberto , Hall Nigel J. , Wright Naomi J. , Major Christina P. , Xerri Thelma , Amin Jasim , Farhad Mustafa , Camilleri-Brennan John F. , Robertson Andrew G. N. , Swann Joanna , Richards James , Jabbar Aijaz , De Bono Phoebe , Attard Myranda , Burns Hannah , Macdonald Euan , Baldacchino Matthew , Skehan Jennifer , Hall Tom Falconer , Gimzewska Madelaine , Mclachlan Greta , Shah Jamie , Chiu James Giles Selina , Weber Beatrix , Chiu Selina Man Yeng , Highcock Saskia , Hassan Maleeha , Beasley William , Vlachogiorgos Apostolos , Dias Stephen , Maharaj Geta , Mcdonald Rosie , Macdonald Alisdair , Witherspoon Paul , Baird Alan , Sarmah Panchali , Green Nikki , Youssef Haney , Cross Kate , Rees Clare M. , Van Duren Bernard , Upchurch Emma , Khan Khurram , Abudeeb Haytham , Hammad Ahmed , Karandikar Sharad , Bowley Doug , Karim Ahmed , Chachulski Witold , Richardson Liam , Dawnay Giles , Thompson Ben , Mistry Ajayesh , Ghetia Millika , Roy Sudipta , Al-Obaedi Ossama , Das Kaustuv , Prabhudesai Ash , Cocker D. M. , Tan Jessica Juliana , Tyler Robert , Di Franco Filippo , Ayyar Shruti , Vivekanantham Sayinthen , Gokani Shyam , Gillespie Michael , Gudlaugsdottir Katrin , Pezas Theodore , Currow Chelise , Kim Matthew Young-Han , Birring Amerdip , Edwards Joanne , Ali Ased , Das Suparna , Jha Madan , Atkinson Kieran , Luck Joshua , Fozard Thomas , Puttick Michael , Salama Yahya , Shah Rohi , Ibrahem Ahmad Aboelkassem , Ebdewi Hamdi , Gravante Gianpiero , El-Rabaa Saleem , Nnajiuba Henry , Allott Rebecca , Bhargava Aman , Chan Zoe , Hassan Zaffar , Makinde Misty , Hemingway David , Dean Ramzana , Boddy Alexander , Aber Ahmed , Patel Vijay , Parakh Jehangirshaw , Parthiban Sunil , Ubhi Harmony Kaur , Hosein Simon-Peter , Ward Simon , Malik Kamran , Jennings Leifa , Newton Tom , Alkhouri Mirna , Kang Min Kyu , Houlden Christopher , Barry Jonathan , Raza Imtanan , Farquharson Alistair , Bhattacharya Sanjeet , Chang Kate , Wilson Michael S. J. , Neo Yan Ning , Ibrahim Ibrahim , Chan Emily , Peck Fraser S. , Lim Pei J. , North Alexander S. , Blundell Rebecca , Williamson Adam , Fouad Dina , Minocha Ashish , Mccarthy Kathryn , Court Emma , Chambers Alice , Yee Jenna , Tham Ji Chung , Beaton Ceri , Walsh Una , Lockey Joseph , Bokhari Salman , Howells Lara , Griffiths Megan , Yallop Laura , Singh Shailinder , Nasher Omar , Jackson Paul , Shariffuddin Abdul Muiz , Ho Weng Chee , Wilson Michael Sj , Pabla Gurpreet , Ramzi Saed , Zeidan Shady , Doughty Jennifer , Sinha Sidhartha , Davenport Ross , Lewis Jason , Duffy Leo , Mcaleer Elizabeth , Williams Eleanor , Som Robin , Javed Omar , Boal Matthew , Harrison Nicola , Tafazal Habib , Brogden Tom , Griffiths Ewen , Obute Rhalumi Daniel , Glover Thomas E. , Clark David J. , Boshnaq Mohamed , Akhtar Mansoor , Capleton Pascale , Doughan Samer , Rabie Mohamed , Mohamed Ismail , Samuel Duncan , Dickson Lauren , Kennedy Matthew , Dempster Eleanor , Brown Emma , Maple Natalie , Monaghan Eimear , Wolf Bernhard , Garland Alicia , Mcphee Arthur , Anderson David , Anderson Robert , Hassan Sarah , Smith Dave , Lund Jonathan , Boereboom Catherine , Murphy Jennifer , Tierney Gillian , Tou Samson , Zimmermann Eleanor Franziska , Smart Neil James , Warwick Andrea Marie , Stasinou Theodora , Daniels Ian , Findlay-Cooper Kim , Mitrasinovic Stefan , Ray Swayamjyoti , Varcada Massimo , D’Souza Rovan , Omara Sharif , Spurr Matthew , Parkinson Lucienne , Hanks Anthony , Ma Jennifer , Abington Emily , Ramcharn Meera , Williams Gethin , Winstanley Joseph , Kennedy Ewan D. , Yeung Emily N. W. , Jones Catrin , O’neill Stephen , Lim Shujing Jane , Liew Ignatius , Nair Hari , Fairfield Cameron , Oh Julia , Koh Samantha , Wilson Andrew , Fairfield Catherine , Anandkumar Delran , Kirupagaran Ashok , Jones Timothy F. , Torrance Hew Dt , Fowler Alexander J. , Chandrakumar Charmilie , Patel Priyank , Ashraf Syed Faaz , Lakhani Sonam M. , Mclean Aaron Lawson , Basson Sonia , Batt Jeremy , Bowman Catriona , Stoddart Michael , Benons Natasha , Mason Clare , Harrison Rebecca , Quayle John , Barker Tom , Summerour Virginia , Harper Edward , Smith Caroline , Hampton Matthew , Pitt Sophie K. , Ward Alex E. , O’Connor Timothy , Heywood Emily G. , Chowdhury Abeed , Hossaini Sina , Watson Nicholas Fs , Mckechnie Doug , Farah Ayaan , Chun Anita , Koh Hoey , Lim Grace , Sunderland Graham , Gould Laura , Munipalle P. C. , Rooney H. , Browning D. R. L. , Pereira Bernadette , Nemeth Kristof , Decker Emily , Giuliani Stefano , Shalaby Aly , Shaikh Shafaque , Tan Chern Yan , Palkhi Ebrahim Y. A. , Szczap Aleksandra , Chidambaram Swathikan , Chen Chee Yang , Kulasabanathan Kavian , Chhabra Srishti , Kostov Elisabeth , Harbord Philippe , Barnacle James , Palliyil Madan Mohan , Zikry Mina , Porter Johnathan , Raslan Charef , Hafiz Shazia , Soltani Niksa , Baillie Katie , Singh Priyanka , Sheth Shailee , Patel Kishen , Khalili Mahry , Choi Jeesoo , Benger Matthew , Marples Lucy , Macfarlane Alastair , Thurairaja Ramesh , Boyce Tamsin , Whewell Harriet , Jones Elin , Th’ng Francesca , Robertson Nichola , Mirza Ahmad , Saeed Haroon , Galloway Simon , Elena Gia , Afzal Mohammad , Zakir Mohamed , Sodde Peter , Hand Charles , Sriram Aiesha , Clark Tamsyn , Holton Patrick , Livesey Amy , Sinha Yashashwi , Iqbal Fahad Mujtaba , Bharj Indervir Singh , Rotundo Adriana , Jenvey Cara , Slade Robert , Golding David , Haines Samuel , Abdullah Ali Adel Ne’ma , Tilston Thomas W. , Loughran Dafydd , Donoghue Danielle , Giacci Lorenzo , Sherif Mohamed Ashur , Harrison Peter , Tang Alethea , Kotecha Deevia , Elshaer Mohamed , Urbonas Tomas , Riaz Amjid , Chapman Annie , Acharya Parisha , Shalhoub Joseph , Grossart Cathleen , McMorran David , Mlotshwa Makhosini , Hawkins William , Loizides Sofronis , Krishna Kandaswamy , Orchard Melanie , Ho Chik Wai , Thomson Peter , Khan Shahab , Taylor Fiona , Shukla Jalak , Howie Emma Elizabeth , Macdonald Linda , Komolafe Olusegun , Mcintyre Neil , Cragg James , Parker Jody , Stewart Duncan , Lintin Luke , Tracy Julia , Farooq Tahir , Molina George , Kaafarani Haytham , Beyene Robel , Sava Jack , Scott Mark , Swaroop Mamta , Kennedy Raelene , Azodo Ijeoma A. , Heffernan Daithi , Chun Tristen , Stephen Andrew , Sion Melanie , Weinstein Michael S. , Punja Viren , Bugaev Nikolay , Goodstein Monica , Razmdjou Shadi , Etchill Eric , Puyana Juan Carlos , Kesinger Matthew , Napolitano Lena , To Kathleen , Hemmila Mark , Todd Oliver , Jenner Edward , Hoogakker Ellen , Chen Jacky Hong Chieh , Ismail Lawani , Roi Dylan , Escobar Eugenio Grasset 
Published: April 2018

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 < 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.