Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana

Autor: Temitope E. Arkorful, John S. Oh, Xavier Candela, Christopher S. Hollenbeak, Brandon S. Hendriksen, David Morrell, Richard Ofosu-Akromah, Forster Amponsah-Manu, Laura Keeney, Evans K. Marfo
Rok vydání: 2020
Předmět:
Male
Rural Population
National Health Programs
Exploratory laparotomy
medicine.medical_treatment
Infectious and parasitic diseases
RC109-216
Abdominal Injuries
Ghana
0302 clinical medicine
Risk Factors
Laparotomy
Epidemiology
030212 general & internal medicine
Hospital Mortality
Child
Referral and Consultation
Original Research
030503 health policy & services
Mortality rate
Major trauma
General Medicine
Ileitis
Middle Aged
Child
Preschool
Female
Public aspects of medicine
RA1-1270
0305 other medical science
Adult
Patient Transfer
Reoperation
medicine.medical_specialty
Adolescent
Perforation (oil well)
Patient Readmission
03 medical and health sciences
Sex Factors
medicine
Humans
Surgical Wound Infection
Typhoid Fever
Perioperative Period
Quality Indicators
Health Care
Retrospective Studies
business.industry
Retrospective cohort study
Perioperative
Length of Stay
Protective Factors
medicine.disease
Appendicitis
Logistic Models
Emergency medicine
Peptic Ulcer Perforation
Wounds and Injuries
business
Intussusception
Intestinal Obstruction
Zdroj: Annals of Global Health
Annals of Global Health, Vol 86, Iss 1 (2020)
ISSN: 2214-9996
Popis: Background: Perioperative mortality rate (POMR) has been identified as an important measure of access to safe surgical and anesthesia care in global surgery. There has been limited study on this measure in rural Ghana. In order to identify areas for future quality improvement efforts, we aimed to assess the epidemiology of exploratory laparotomy and to investigate POMR as a benchmark quality measure. Methods: Surgical records were reviewed at a regional referral hospital in Eastern Region, Ghana to identify cases of exploratory laparotomy from July 2017 through June 2018. Patient demographics, health information, and outcomes data were collected. Logistic regression was used to identify predictors of perioperative mortality. Findings: The study included operations for 286 adult and 60 pediatric patients. Only 60% of patients were covered by National Health Insurance (NHI). The overall POMR was 11.5% (12.6% adults; 6.7% pediatric). Sixty percent of mortalities were referrals from outside hospitals and the mortality rate for referrals was 13.5%. Odds of mortality was 13 times greater with perforated peptic ulcer disease (OR = 13.1, p = 0.025) and 12 times greater with trauma (OR = 11.7, p = 0.042) when compared to the most common operation. Female sex (OR = 0.3, p = 0.016) and NHI (OR = 0.4, p = 0.031) were protective variables. Individuals 60 years and older (OR = 3.3, p = 0.016) had higher mortality. Conclusion: POMR can be an important outcome and quality indicator for rural populations. Interventions aimed at decreasing emergent hernia repair, preventing perforation of peptic ulcer disease, improving rural infrastructure for response to major trauma, and increasing NHI coverage may improve POMR in rural Ghana.
Databáze: OpenAIRE
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