Outcome assessment of emergency laparotomies and associated factors in low resource setting. A case series
| Autor: | Abatneh Feleke Agegnehu, Endale Gebreegziabher Gebremedhn, Bernard Bradley Anderson |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment 030230 surgery Low resource setting 03 medical and health sciences 0302 clinical medicine Level of consciousness 030202 anesthesiology Laparotomy medicine Mortality Original Research business.industry Associated factors Incidence (epidemiology) General surgery Emergency laparotomy General Medicine Odds ratio Perioperative Bowel resection Checklist Surgery Observational study Morbidity business |
| Zdroj: | Annals of Medicine and Surgery |
| ISSN: | 2049-0801 |
| Popis: | Background Emergency 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. Methods An 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. Result A 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 recommendation The 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. Highlights • Emergency laparotomy caused morbidity and mortality in 39.2% and 3.5% patients respectively. • Large bowel resection and re-operation contributed most to morbidity and mortality. • Delayed arrival at hospital and delayed surgical interventions were the main problems. |
| Databáze: | OpenAIRE |
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