Indications and Outcomes for Non-Trauma Emergency Laparotomy: A Comparison of Rwanda, South Africa, and the USA
Autor: | Surita Englbrecht, Isaie Sibomana, Sekoaere Malatji, Linda Pohl, Nazmie Kariem, Jennifer Rickard, Alexandria J. Robbins, Kathryn Chu, Egide Abahuje, C. Kloppers |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
Exploratory laparotomy business.industry medicine.medical_treatment Perforation (oil well) Odds ratio Perioperative 030230 surgery medicine.disease Appendicitis Bowel obstruction 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Internal medicine medicine Surgery business Prospective cohort study Abdominal surgery |
Zdroj: | World Journal of Surgery. 45:668-677 |
ISSN: | 1432-2323 0364-2313 |
Popis: | Emergency conditions requiring exploratory laparotomy (EL) can be challenging. The objective of this study is to describe indications, outcomes, and risk factors for perioperative mortality (POMR) after non-trauma EL. This was a prospective study of patients undergoing non-trauma EL at four hospitals in Rwanda, South Africa, and the USA. Multivariate logistic regression was used to determine factors associated with POMR. Over one year, there were 632 EL with the most common indications appendicitis (n = 133, 21%), peptic ulcer disease (PUD) (n = 101, 16%), and hernia (n = 74, 12%). In Rwanda, the most common indications were appendicitis (n = 41, 19%) and hernia (n = 37, 17%); in South Africa appendicitis (n = 91, 28%) and PUD (n = 60, 19%); and in the USA, PUD (n = 16, 19%) and adhesions from small bowel obstruction (n = 16, 19%). POMR was 11%, with no difference between countries (Rwanda 7%, South Africa 12%, US 16%, p = 0.173). Risk factors associated with increased odds of POMR included typhoid intestinal perforation (adjusted odds ratio (aOR): 16.48; 95% confidence interval (CI): 4.31, 62.98; p value 60 years (aOR: 2.32, 95% CI: 1.41, 3.83, p value = 0.001), and ICU admission (aOR: 2.23, 95% CI: 1.24, 3.99, p value = 0.007). Surgery in the US was associated with decreased odds of POMR (aOR: 0.41, 95% CI: 0.21, 0.80, p value = 0.009). Indications for EL vary between countries and POMR is high. Differences in mortality were associated with patient and disease characteristics with certain diagnoses associated with increased risk of mortality. Understanding the risk factors and outcomes for patients with EL can assist providers in judicious patient selection, both for patient counselling and resource allocation. |
Databáze: | OpenAIRE |
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