Postoperative Complications and Risk of Mortality after Laparotomy in a Resource-Limited Setting

Sincavage, John; Msosa, Vanessa; Katete, Chawezi; Purcell, Laura N.; Charles, Anthony

doi:10.1016/j.jss.2020.11.017

Cited by 6 publications

(4 citation statements)

References 35 publications

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“…The observed in-hospital mortality rate in our study was 10.6%. This is consistent with prior studies in resource-limited areas which reported a mortality rate ranging between 5.5% and 22.4% [ 4 , 6 , 17 , 19 , 26 , 27 ]. Compared to findings from a global survey [ 28 ], we had a higher mortality rate in our cohort.…”

Section: Discussionsupporting

confidence: 93%

Surgical Apgar score as a predictor of outcomes in patients following laparotomy at Mulago National Referral Hospital, Uganda: a prospective cohort study

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 93%

Surgical Apgar score as a predictor of outcomes in patients following laparotomy at Mulago National Referral Hospital, Uganda: a prospective cohort study

et al. 2022

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“…Assessment of patient age and physical condition ASA may help improve surgical intervention to improve outcomes (36). This nding is supported by studies done in Malawi (12), UK (37)(38)(39), Singapore (40), USA (33) ,Turkey (41) and Ireland, (42). The possible explanation for this consistency is that, patients ASA status contributes to reduced physiological reserve and that the negative effect of underlying abdominal pathology may contributes to an increased risk of postoperative mortality in patients undergone laparotomy (43).…”

Section: Discussionmentioning

confidence: 75%

“…The rst study conducted in the USA included only patients 16 years of age or older, and the second study included patients 55 year of age and older. The previous study showed that study subjects were the elderly group, the risk of death after laparotomy surgery increased (12,35).…”

Section: Discussionmentioning

confidence: 99%

“…Laparotomy is one of the top three surgical treatments in sub-Saharan Africa (10), an account for a higher proportion of surgical procedures and contributes 2 to 3 times higher in-hospital mortality (11). Study from Malawi and Tanzania showed the overall rate of in-hospital mortality after laparotomy to be 14.8% and 17%, respectively (12,13). A study from Ethiopia showed that mortality after laparotomy was 8.1% and 8.5% (14,15).…”

Section: Introductionmentioning

confidence: 99%

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Magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary public hospitals, West Oromia, Ethiopia, 2022

Benti,

Tesgera,

Alemshet

2023

Preprint

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Introduction: Laparotomy surgery is an incision in the abdominal cavity to treat serious abdominal disease and save the patient's life. It is performed in both elective and emergency conditions and results in significant deaths in both developed and developing countries, including Ethiopia. Studies of in-hospital mortality among patients undergone laparotomy surgery and associated factors are limited. Objective: To assess the magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary hospitals, West Oromia, Ethiopia, 2022. Method: An institutional retrospective cross-sectional study was donefrom January 1, 2017 to December 31, 2021. Data were collected using systematic random sampling and basedstructured and pre-tested abstraction sheet from 548 patient chars and registries.Data were checked for completeness, consistency, coded, importedusing EPI data version 4.6, cleaned and analyzedusing SPSS version 25. Variables with p < 0.2 in bi-variable logistic regression analysis were included in themultivariate logistic regression analysis. The model fitness was checked by the Hosmer-Lemeshow test. Using the adjusted odds ratio with 95% CI and a p-value of 0.05, statistical significance was declared. Results: A total of 512 patient records were reviewed and the response rate was 93.43%. The overall in-hospital mortality rate was 7.42% [95% CI: 5.4-9.8]. American Anaesthesiology Association physiological status of patients ≥ III [AOR=7.64 (95% CI: 3.12-18.66)], systolic blood pressure <90 mmHg at admission [AOR=6.11 (95% CI: 1.98-18.80)], presence of preoperative sepsis [AOR= 3.54 (95% CI: 1.53-8.19)], Intensive care unit admission [AOR = 4.75 (95% CI: 1.50-14.96)], and hospital stay ≥14 days [(AOR = 6.76 (95% CI: 2.50-18.26)] were significantly associated with in-hospital mortality after laparotomy surgery. Concussion: In this study,overall in-hospital mortality was high. TheAmerican Society of Anaesthesiologists identifies the patient's physical condition early, requires appropriate intervention,and pays special attention to patients: low systolic blood pressure, preoperative sepsis, admission to the hospital, Intensive care unit and prolonged hospital stay, in order to improve patient outcomes after laparotomy surgery.

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Predictors of mortality for perforated peptic ulcer disease in Malawi

Davis

Kayange

et al. 2023

The American Journal of Surgery

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Postoperative Complications and Risk of Mortality after Laparotomy in a Resource-Limited Setting

Cited by 6 publications

References 35 publications

Surgical Apgar score as a predictor of outcomes in patients following laparotomy at Mulago National Referral Hospital, Uganda: a prospective cohort study

Surgical Apgar score as a predictor of outcomes in patients following laparotomy at Mulago National Referral Hospital, Uganda: a prospective cohort study

Magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary public hospitals, West Oromia, Ethiopia, 2022

Predictors of mortality for perforated peptic ulcer disease in Malawi

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