Background Postoperative complications and mortality following laparotomy have remained high worldwide. Early postoperative risk stratification is essential to improve outcomes and clinical care. The surgical Apgar score (SAS) is a simple and objective bedside prediction tool that can guide a surgeon’s postoperative decision making. The objective of this study was to evaluate the performance of SAS in predicting outcomes in patients undergoing laparotomy at Mulago hospital. Method A prospective observational study was conducted among eligible adult patients undergoing laparotomy at Mulago hospital and followed up for 4 months. We collected data on the patient’s preoperative and intraoperative characteristics. Using the data generated, SAS was calculated, and patients were classified into 3 groups namely: low (8–10), medium (5–7), and high (0–4). Primary outcomes were in-hospital major complications and mortality. Data was presented as proportions or mean (standard deviation) or median (interquartile range) as appropriate. We used inferential statistics to determine the association between the SAS and the primary outcomes while the SAS discriminatory ability was determined from the receiver-operating curve (ROC) analysis. Results Of the 151 participants recruited, 103 (68.2%) were male and the mean age was 40.6 ± 15. Overall postoperative in-hospital major complications and mortality rates were 24.2% and 10.6%, respectively. The participants with a high SAS category had an18.4 times risk (95% CI, 1.9–177, p = 0.012) of developing major complications, while those in medium SAS category had 3.9 times risk (95% CI, 1.01–15.26, p = 0.048) of dying. SAS had a fair discriminatory ability for in-hospital major complications and mortality with the area under the curve of 0.75 and 0.77, respectively. The sensitivity and specificity of SAS ≤ 6 for major complications were 60.5% and 81.14% respectively, and for death 54.8% and 81.3%, respectively. Conclusion SAS of ≤ 6 is associated with an increased risk of major complications and/or mortality. SAS has a high specificity with an overall fair discriminatory ability of predicting the risk of developing in-hospital major complications and/or death following laparotomy.
The incidence of HIV in Uganda as reported by UNAIDS (2012) was increased from 6.7% in 2004 to 7.6% to 2012. The main threat to HIV-infected patients following surgery is the development of sepsis. Inadequacy of surgical supplies and human resources further hastens and complicates the postoperative sepsis in HIV patients. The objective of the study was to determine incidence and risk factors associated with postoperative sepsis, among HIV seropositive with acute abdomen. A prospective study ran for a period of 11 months from October 2015 to April 2016 in Mulago Hospital in Kampala. Eligible patients were recruited and included. Study variables included postoperative wound sepsis, type of surgery, and CD4 counts. Thirty-eight data were collected using a questionnaire then entered in the Epidata software 3.1 and analyzed by Stata software version. Sixty-two patients were recruited; of these, 42 were male, 37 were HIV-negative and 25 were HIV-positive. The proportion of patients with postoperative sepsis in the HIVpositive group was 7 (28%) and in the HIV-negative group was 8 (21.6%). The number of patients discharged in HIV-positive group was 24 (96%) and in HIV-negative group was 35 (94.6%). Among the HIV-positive group was 1 out of 25 (4) % and HIV-negative was 2 out of 37 (5.4%). The overall postoperative sepsis incidence rate was 3 per 100 person days for under observation (95% CI 0.02-0.1), and the incidence rate ratio of HIV-positive patients and HIV-negative was 1.04 (95% CI 0.32-3.3; P = 0.47. The limited health resource was associated with developing postoperative sepsis. There was a higher risk of positive operative sepsis among HIV-positive compared to HIV-negative patients undergoing surgery for acute abdominal conditions.
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