Abstract
BackgroundEmergency 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.MethodsAn 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.ResultA 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 recommendationThe 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 (EP) is a common procedure which associated with substantial postoperative morbidity and mortality [1,2]
This study revealed that the overall incidence of postoperative morbidity and mortality were 39.2% (102/260) and 3.5% (9/260) within 30 days of operation respectively
The incidence of postoperative morbidity and mortality were high in our University tertiary teaching and referral hospital
Summary
Emergency laparotomy (EP) is a common procedure which associated with substantial postoperative morbidity and mortality [1,2]. Perioperative management of patients undergoing emergency laparotomy in middle and low-income countries is extremely challenging, and causes high postoperative 30day patient morbidity and mortality as well as imposes a high healthcare cost burden [9]. There is paucity of evidence on postoperative patient morbidity and mortality after emergency laparotomy in resource-limited settings which hamper the establishment of evidence-based optimal perioperative care bundle [9]. In low-income countries, there are large volumes of emergency patients who need surgical care Infrastructures such as operation rooms, advanced equipment, skilled human resources, investigation modalities such as Computerized tomography (CT) scan, Magnetic Resonance Imaging (MRI), Ultrasound (US) and drugs are limited [9]. 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
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