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

Abstract

Background: Surgical intervention is one of the core components of the health care system, yet not free of risks. Once postoperative complications occur, patients are subjected to extra costs for treatment, longer hospital stay, and associated disabilities. The chance of death also increases once patients develop postoperative complications. However, the extent of in-hospital postoperative complications was not well studied in Ethiopia, particularly in the Eastern part of the country. As a result, this study was aimed to determine the magnitude of postoperative complications and to identify associated factors among surgical patients treated at a tertiary hospital, eastern Ethiopia. Methods: A prospective cohort study was conducted from July 1, 2019 to January 30, 2020. Patients from general surgery, neurosurgery, orthopedic, and pediatric surgery were incorporated into the study. The calculated sample size was 384 using single population formulas. Data were analyzed using SPSS version 23. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with postoperative complications. The significance level of associations was considered with a P-value <0.05 and an adjusted odds ratio (AOR) at a 95% confidence interval(CI). Results: 8The magnitude of postoperative complications was 12.5% (95% CI=9.4-16.2%). From those who had developed postoperative complications, 20.5% were deceased. Factors associated with postoperative complications were cigarette smoking (AOR=4.02, 95% CI=1.86-8.66), patients with a morbidity status according to the American Society of Anesthesiologists (ASA) category 2 (AOR=7.83; 95% CI=2.95-20.75), ASA 3 (AOR=9.62; 95% CI=1.70-54.46), and ASA 4 (AOR=3.25; 95% CI=1.22-8.60), operative hours of 1-2 hours duration (AOR=3.38; 95% CI=1.45-7.94), operative hours of more than 2 hours (AOR=4.36; 95% CI=1.91-9.95), and intraoperative complications (AOR=5.96; 95% CI=1. 707-20.87). Conclusion: This study showed a higher proportion of postoperative complications associated mortality rates compared to similar studies across the world. The majority of patients who developed complications and died were those who were operated on on an emergency basis. This mandates to follow the damage control surgery protocol, though further study might be needed to sort out the likely causes for this increased risk.

Early Postoperative Complications of Gastrointestinal Surgery and Its Associated Factors in Yemeni Patients Treated in a Teaching Hospital: A Retrospective Monocentric Study

“…Our study reveals that having surgery for more than two hours does not increase the risk of developing early POCs. Our result is in contrast to that of Bayissa et al's study [ 26 ]. The authors demonstrated that the longer the operative time, the greater the risk of overall complications such as reoperation, medical and surgical complications, and superficial surgical site infections [ 26 ].…”

“…Our result is in contrast to that of Bayissa et al's study [ 26 ]. The authors demonstrated that the longer the operative time, the greater the risk of overall complications such as reoperation, medical and surgical complications, and superficial surgical site infections [ 26 ]. These discrepancies may be related to the teaching hospital and most surgeries performed by residents with attending supervision, leading to more time for performing surgical procedures.…”

“…In our study, there was a significant relationship between POCs and iatrogenic injuries. A similar result was reported by Bayissa et al [ 26 ].…”

Incidence and Predictors of Mortality Among Patients with Traumatic Brain Injury at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: A Retrospective Follow-Up Study

“…40 Post-operative complication: Adverse events such as pneumonia, meningitis, wound infection, postoperative wound dehiscence, reoperation occur as a consequence of tissue injury due to surgery or anesthesia, following Surgery and Anesthesia. 41 Unfavorable outcome: is the mortality/death following TBI.…”

Improving surgical safety checklist utilisation at 23 public health facilities in Ethiopia: a collaborative quality improvement project

“…Studies reported adverse events can occur in up to 14% of patients who have undergone surgery while mortality ranges between 1% and 4% 2 3. Similarly in Ethiopia, adverse events occur in 12% of surgical patients 4. However, the incidence of surgical complications has not shown a significant change over the past two decades 5 6.…”