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Br J Surg 2016 103: 971–988.Īrnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Mortality of emergency abdominal surgery in high‐, middle‐ and low‐income countries. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A et al. BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3♲0, 95 per cent c.i. There was a higher proportion of patients with perforated disease (57♵, 40♹ and 35♴ per cent P < 0♰01) and subsequent use of end colostomy (52♲, 24♸ and 18♹ per cent P < 0♰01) in low- compared with middle- and high-HDI settings. In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6♹ per cent) from low-HDI, 254 (15♵ per cent) from middle-HDI and 1268 (77♶ per cent) from high-HDI countries. Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors.