Abstract
BackgroundGastrointestinal 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.MethodsTwo 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.ResultsA 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).ConclusionsWith 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.
Highlights
Collaborating members are listed in the Acknowledgments.Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Typhoid fever is caused primarily by a gram-negative Salmonella enterica species (Salmonella typhi and Salmonella paratyphi)
A total of 88 patients from 11 countries underwent a surgical procedure for gastrointestinal typhoid perforation during the data collection periods (Fig. 1)
Validation performed in the GlobalSurg 2 data set demonstrated this approach to have a 93.3% case ascertainment rate and a high accuracy for categorical predictors (Cohen’s kappa coefficients [ 0.90), continuous predictors (Pearson’s correlation coefficient 0.99) and mortality rate
Summary
Typhoid fever is caused primarily by a gram-negative Salmonella enterica species (Salmonella typhi and Salmonella paratyphi). It is commonly transmitted via the faeco-oral route and is epidemic in areas with poor sanitation and limited availability of clean water. One of the common complications of typhoid fever is gastrointestinal perforation, which usually requires emergency surgery [1]. These perforations normally occur in the jejunum or ileum, but there have been several reported cases of colonic and even gallbladder perforations [2]. The. Gastrointestinal perforation is the most serious complication of typhoid fever, with a high disease burden in low-income countries. This study aimed to investigate surgical outcomes following surgery for intestinal typhoid
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