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Published in: World Journal of Surgery 12/2018

01-12-2018 | Original Scientific Report

Management of Appendicitis Globally Based on Income of Countries (MAGIC) Study

Authors: Carlos Augusto Gomes, Fikri M. Abu-Zidan, Massimo Sartelli, Federico Coccolini, Luca Ansaloni, Gian Luca Baiocchi, Yoram Kluger, Salomone Di Saverio, Fausto Catena

Published in: World Journal of Surgery | Issue 12/2018

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Abstract

Background

Our aim is to compare the management approaches and clinical outcomes of acute appendicitis according to annual Gross National Income per Capita (GNI/Capita) of countries.

Methods

Consecutive patients who were diagnosed to have acute appendicitis from 116 centers of 44 countries were prospectively studied over a 6-month period (April–September 2016). Studied variables included demography, Alvarado score, comorbidities, radiological and surgical management, histopathology, and clinical outcome. Data were divided into three groups depending on the GNI/Capita.

Results

A total of 4271 patients having a mean (SD) age of 33.4 (17.3) years were studied. Fifty-five percent were males. Two hundred and eighty patients were from lower–middle-income (LMI) countries, 1756 were from upper–middle-income (UMI) countries, and 2235 were from high-income (HI) countries. Patients in LMI countries were significantly younger (p < 0.0001) and included more males (p < 0.0001). CT scan was done in less than 8% of cases in LMI countries, 23% in UMI countries, and 38% in HI countries. Laparoscopy was performed in 73% of the cases in the HI countries, while open appendectomy was done in more than 60% of cases in both LMI and UMI countries (p < 0.0001). The longest mean hospital stay was in the UMI group (4.84 days). There was no significant difference in the complication or death rates between the three groups. The overall death rate was 3 per 1000 patients.

Conclusions

There is great variation in the presentation, severity of disease, radiological workup, and surgical management of patients having acute appendicitis that is related to country income. A global effort is needed to address this variation. Individual socioeconomic status could be more important than global country socioeconomic status in predicting clinical outcome.
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Metadata
Title
Management of Appendicitis Globally Based on Income of Countries (MAGIC) Study
Authors
Carlos Augusto Gomes
Fikri M. Abu-Zidan
Massimo Sartelli
Federico Coccolini
Luca Ansaloni
Gian Luca Baiocchi
Yoram Kluger
Salomone Di Saverio
Fausto Catena
Publication date
01-12-2018
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 12/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4736-1

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