Mortality, morbidity, and post-operative complications of typhoid intestinal perforations: global systematic review and meta-analysis

Objective: We aimed to review global studies reporting on mortality, morbidity, and post-operative complications in patients with typhoid intestinal perforation (TIP). Summary Background Data: TIP is a serious and life-threatening complication of typhoid fever that requires emergency surgery and an important driver of typhoid burden. Methods: We searched multiple databases for articles reporting case-fatality ratio (CFR) or complications in patients with TIP undergoing surgery published from 1980 through 30 January 2024. We described the prevalence of each reported complication. Of patients with TIP, we pooled CFR using random-effects meta-analysis and stratified by United Nations region, sex, and number of perforations per patient. Results: We included 46 articles reporting on 4,317 patients with TIP. The most prevalent post-operative complications were wound or surgical site infection in 1,537 (50.7%) of 3,030 patients, wound dehiscence in 308 (16.1%) of 1,909, and chest infection in 136 (15.6%) of 872. Overall, the pooled CFR (95%CI) of patients with TIP was 15.6% (12.5-18.9%), and was 20.5% (17.1-23.9%) in 30 observations from the African region, 5.7% (2.6-9.6%) in 15 observations from the Asian region, and 12.2% (0.90-30.4%) in three observations from the Americas. The Pearsons correlation coefficient of median year of data collection and CFR was -0.01 (p=0.95) for Africa and -0.69 (p <0.01) for Asia. Conclusions Disability and death associated with TIP remains substantial. Efforts to reduce the occurrence of TIP through typhoid prevention with vaccine and non-vaccine measures, and increased access to and quality of surgical services for those with TIP are warranted.