{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:45:05Z","timestamp":1790390705618,"version":"4.1.0"},"reference-count":116,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T00:00:00Z","timestamp":1745625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T00:00:00Z","timestamp":1745625600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute appendicitis is a common surgical emergency worldwide, with significant variations in prevalence, presentation and outcomes between high\u2010income countries (HIC) and low\u2010 and middle\u2010income countries (LMIC). Complicated appendicitis has significant implications for low\u2010 and lower\u2010middle\u2010income countries due to limited healthcare resources. While there is extensive evidence for HICs, the evidence for low\u2010 and lower\u2010middle\u2010income countries is lacking. This systematic review aimed to compare the prevalence of complicated appendicitis between low\u2010income countries (LICs) and lower\u2010middle\u2010income countries (LoMICs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was conducted following PRISMA guidelines (PROSPERO CRD42024526007). Observational studies and randomized controlled trials published in PubMed, MEDLINE, Embase and Scopus (1990\u20132024) were retrieved. A grey literature search of Google Scholar and the Cochrane Library was also performed to identify existing reviews on the topic. The primary outcome investigated was the incidence of complicated appendicitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty\u2010seven articles with 25\u2009582 participants were included. Meta\u2010analyses of outcomes comparing LICs to LoMICs identified an increased pooled proportion of complicated appendicitis (34% (95% CI 27%\u201341%) vs. 23% (95% CI 19%\u201327%)\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), increased post\u2010operative morbidity (19% (95% CI 13%\u201327%) vs. 13% (95% CI 8%\u201320%):\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01) and mortality (OR 2.36).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Appendicitis remains a major burden in LICs and LoMICs with higher rates of morbidity and mortality. These findings highlight critical deficiencies in surgical access and delivery, underscoring the need for targeted interventions to improve outcomes in these settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70103","type":"journal-article","created":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T03:49:32Z","timestamp":1745639372000},"page":"1096-1107","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Complicated appendicitis in low\u2010 and lower\u2010middle\u2010income countries: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8004-6716","authenticated-orcid":false,"given":"Renato","family":"Pitesa","sequence":"first","affiliation":[{"name":"Department of Surgery The University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4376-4118","authenticated-orcid":false,"given":"Claudia","family":"Paterson","sequence":"additional","affiliation":[{"name":"Department of Surgery The University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Flaherty","sequence":"additional","affiliation":[{"name":"Department of Surgery The University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy","family":"Eteuati","sequence":"additional","affiliation":[{"name":"Department of Surgery Middlemore Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8672-6379","authenticated-orcid":false,"given":"Andrew G.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Surgery The University of Auckland  Auckland New Zealand"},{"name":"Department of Surgery Middlemore Hospital  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,26]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(24)00157-2"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-023-07183-2"},{"key":"e_1_2_10_4_1","first-page":"1","article-title":"Spontaneous resolution of uncomplicated appendicitis may explain increase in proportion of complicated appendicitis during Covid\u201019 pandemic: a systematic review and meta\u2010analysis","volume":"47","author":"Andersson RE","year":"2023","journal-title":"World J. 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