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The objective of this study is to describe indications, outcomes, and risk factors for perioperative mortality (POMR) after non\u2010trauma EL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective study of patients undergoing non\u2010trauma EL at four hospitals in Rwanda, South Africa, and the USA. Multivariate logistic regression was used to determine factors associated with POMR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over one year, there were 632 EL with the most common indications appendicitis (<jats:italic>n<\/jats:italic>\u2009=\u2009133, 21%), peptic ulcer disease (PUD) (<jats:italic>n<\/jats:italic>\u2009=\u2009101, 16%), and hernia (<jats:italic>n<\/jats:italic>\u2009=\u200974, 12%). In Rwanda, the most common indications were appendicitis (<jats:italic>n<\/jats:italic>\u2009=\u200941, 19%) and hernia (<jats:italic>n<\/jats:italic>\u2009=\u200937, 17%); in South Africa appendicitis (<jats:italic>n<\/jats:italic>\u2009=\u200991, 28%) and PUD (<jats:italic>n<\/jats:italic>\u2009=\u200960, 19%); and in the USA, PUD (<jats:italic>n<\/jats:italic>\u2009=\u200916, 19%) and adhesions from small bowel obstruction (<jats:italic>n<\/jats:italic>\u2009=\u200916, 19%).<\/jats:p><jats:p>POMR was 11%, with no difference between countries (Rwanda 7%, South Africa 12%, US 16%, <jats:italic>p<\/jats:italic>\u2009=\u20090.173). Risk factors associated with increased odds of POMR included typhoid intestinal perforation (adjusted odds ratio (aOR): 16.48; 95% confidence interval (CI): 4.31, 62.98; <jats:italic>p<\/jats:italic> value\u2009&lt;\u20090.001), mesenteric ischemia (aOR: 13.77, 95% CI: 4.21, 45.08, <jats:italic>p<\/jats:italic> value\u2009&lt;\u20090.001), cancer (aOR: 5.84, 95% CI: 2.43, 14.05, <jats:italic>p<\/jats:italic> value\u2009&lt;\u20090.001), other diagnoses (aOR: 3.97, 95% CI: 3.03, 5.20, <jats:italic>p<\/jats:italic> value\u2009&lt;\u20090.001), high ASA score (score\u2009\u2265\u20093) (aOR: 3.95, 95% CI: 3.03, 5.15, <jats:italic>p<\/jats:italic> value\u2009&lt;\u20090.001), peptic ulcer disease (aOR: 2.82, 95% CI: 1.64, 4.85, <jats:italic>p<\/jats:italic> value\u2009&lt;\u20090.001), age\u2009&gt;\u200960 years (aOR: 2.32, 95% CI: 1.41, 3.83, <jats:italic>p<\/jats:italic> value\u2009=\u20090.001), and ICU admission (aOR: 2.23, 95% CI: 1.24, 3.99, <jats:italic>p<\/jats:italic> value\u2009=\u20090.007). Surgery in the US was associated with decreased odds of POMR (aOR: 0.41, 95% CI: 0.21, 0.80, <jats:italic>p<\/jats:italic> value\u2009=\u20090.009).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Indications for EL vary between countries and POMR is high. Differences in mortality were associated with patient and disease characteristics with certain diagnoses associated with increased risk of mortality. Understanding the risk factors and outcomes for patients with EL can assist providers in judicious patient selection, both for patient counselling and resource allocation.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-020-05862-y","type":"journal-article","created":{"date-parts":[[2020,11,22]],"date-time":"2020-11-22T21:02:17Z","timestamp":1606078937000},"page":"668-677","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Indications and Outcomes for Non\u2010Trauma Emergency Laparotomy: A Comparison of Rwanda, South Africa, and the USA"],"prefix":"10.1002","volume":"45","author":[{"given":"Jennifer","family":"Rickard","sequence":"first","affiliation":[{"name":"Department of Surgery University Teaching Hospital of Kigali Kigali Rwanda"},{"name":"Department of Surgery University of Minnesota 420 Delaware St SE, MMC 195 55455 Minneapolis MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Pohl","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Cape Town Cape Town South Africa"},{"name":"Department of Surgery New Somerset Hospital Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Egide","family":"Abahuje","sequence":"additional","affiliation":[{"name":"Department of Surgery University Teaching Hospital of Kigali Kigali Rwanda"},{"name":"Department of Surgery University of Rwanda Kigali Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazmie","family":"Kariem","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Cape Town Cape Town South Africa"},{"name":"Department of Surgery New Somerset Hospital Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Surita","family":"Englbrecht","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Cape Town Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christo","family":"Kloppers","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Cape Town Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sekoaere","family":"Malatji","sequence":"additional","affiliation":[{"name":"Department of Surgery New Somerset Hospital Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isaie","family":"Sibomana","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Rwanda Kigali Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandria J.","family":"Robbins","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Minnesota 420 Delaware St SE, MMC 195 55455 Minneapolis MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Cape Town Cape Town South Africa"},{"name":"Department of Surgery New Somerset Hospital Cape Town South Africa"},{"name":"Department of Global Health Stellenbosch University Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,11,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60160\u2010X"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(18)30001\u20101"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010016\u20103614\u2010y"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10151"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aes165"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2012.06.004"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2010.137"},{"key":"e_1_2_8_9_1","unstructured":"World Bank Country and Lending Groups: The World Bank Group; (2019) [18 February 2019]. 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