Outcome assessment of emergency laparotomies and associated factors in low resource setting. A case series

Abstract

BackgroundEmergency laparotomy is a high risk procedure which is demonstrated by high morbidity and mortality. However, the problem is tremendous in resource limited settings and there is limited data on patient outcome. We aimed to assess postoperative patient outcome after emergency laparotomy and associated factors.MethodsAn observational study was conducted in our hospital from March 11- June 30, 2015 using emergency laparotomy network tool. All consecutive surgical patients who underwent emergency laparotomy were included. Binary and multiple logistic regressions were employed using adjusted odds ratios and 95% CI, and P-value < 0.05 was considered to be statistically significant.ResultA total of 260 patients were included in the study. The majority of patients had late presentation (>6hrs) to the hospital after the onset of symptoms of the diseases and surgical intervention after hospital admission. The incidences of postoperative morbidity and mortality were 39.2% and 3.5% respectively. Factors associated with postoperative morbidity were preoperative co-morbidity (AOR = 0.383, CI = 0.156–0.939) and bowel resection (AOR = 0.232, CI = 0.091–0.591). Factors associated with postoperative mortality were anesthetists' preoperative opinion on postoperative patient outcome (AOR = 0.067, CI = 0.008–0.564), level of consciousness during recovery from anaesthesia (AOR = 0.114, CI = 0.021–10.628) and any re-intervention within 30 days after primary operation (AOR = 0.083, CI = 0.009–0.750).Conclusion and recommendationThe incidence of postoperative morbidity and mortality after emergency laparotomy were high. We recommend preoperative optimization, early surgical intervention, and involvement of senior professionals during operation in these risky surgical patients. Also, we recommend the use of WHO or equivalent Surgical Safety Checklist and establishment of perioperative patient care bundle including surgical ICU and radiology investigation modalities such as CT scan.

Postoperative Complications and Associated Factors Among Surgical Patients Treated at a Tertiary Hospital, Eastern Ethiopia: A Prospective Cohort Study

“…The magnitude of postoperative complications according to our study was 12.5%, which is similar to the global outcome study, 11.7%, 6 and lower than an African outcome cohort study which was 18.2%. 23 The study was conducted in different parts of Ethiopia, and showed higher complication rate as compared to the current findings, which was 39.2% in Gondar teaching and referral hospital 8 and 17% in Attat general hospital, Gurage zone. 9 These discrepancies may be related to the relatively better quality of surgical care delivery and the presence of qualified health care workers at a tertiary hospital compared to primary and general hospitals in Ethiopia and others were studies comprising limited systems like post-laparotomy.…”

“…9 These discrepancies may be related to the relatively better quality of surgical care delivery and the presence of qualified health care workers at a tertiary hospital compared to primary and general hospitals in Ethiopia and others were studies comprising limited systems like post-laparotomy. 8 The overall mortality rate following all types of surgery was 2.5%. But the magnitude of death in patients who had already developed complications was significantly higher, 20.5%.…”

“…The single population proportion formula was employed to calculate the sample size by considering the assumptions: standard normal distribution (Z=1.96), with a onfidence interval of 95% and α=0.05; prevalence of postoperative complication (P=39.2%), 8 margin of error (d=5%). The sample final size was calculated to be 384 after adding a 5% non-response rate.…”

“…6 The magnitude of postoperative complications varies depending on the quality of service, availability of human resources and materials in health care facilities. 7 According to the study conducted in one tertiary hospital in Ethiopia, the prevalence of postoperative complications were 39.2% among patients who underwent emergency laparotomies 8 and 17% among patients who were surgically treated for an acute abdomen. 9 Moreover, studies established factors linked with postoperative complications include; smoking, 10 higher body mass index, combined organ resection, 11 older age, comorbidities, 8,12 longer duration of surgery, anesthesia, 13,14 intraoperative adverse events, 15,16 and higher ASA class.…”

“…7 According to the study conducted in one tertiary hospital in Ethiopia, the prevalence of postoperative complications were 39.2% among patients who underwent emergency laparotomies 8 and 17% among patients who were surgically treated for an acute abdomen. 9 Moreover, studies established factors linked with postoperative complications include; smoking, 10 higher body mass index, combined organ resection, 11 older age, comorbidities, 8,12 longer duration of surgery, anesthesia, 13,14 intraoperative adverse events, 15,16 and higher ASA class. 17,18 In Ethiopia, the lack of adequate skilled human resources, inadequate surgical equipment, and supplies has endangered the limited surgical procedure's safety and success.…”