MORBIDITY, MORTALITY AND ASSOCIATED FACTORS IN PATIENTS WITH EMERGENCY LAPAROTOMY

Abstract

ABSTRACT BACKGROUND: Emergency surgery is specialty of surgery where decisions often need to be made urgently. An emergency laparotomy is a major operation that involves opening the abdomen (tummy) which allows the surgeon to view the organs inside and repair any emergency problems that have occurred. It is called “emergency” because it must be done very soon or even immediately and cannot wait until a later date. Emergency laparotomies are associated with high mortality and substantial outcome variation. OBJECTIVE: To determine Morbidity, Mortality and Associated factors in patients for whom emergency laparotomy was done in SPHMMC surgical ward, Addis Ababa, Ethiopia, from September 1/2016 to August 30 /2017. METHODS: -A retrospective record review Study design was conducted from October /2017 - August /2018 G.C, at St Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia. Study subjects was identified from the hospital log books (admission, discharge and operation) and individual patient charts was reviewed for the study variables. The data was collected by trained final year medical students. After data was collected and data was analyzed using SPSS software. The analyzed data presented using charts, tables, and graphs and described using texts. RESULT: A total of 390 emergency laparotomies were performed during the study period. Among those the records of 320 patients were retrieved for analysis making a retrieval rate of 82.01%.One hundred and five (33.4%) of operated patients had early (in-hospital) postoperative complications. The commonest complication was wound infection 42(13.1%), followed by Sepsis 25(7.8%) and pneumonia 21(6.67%).Overall, 35(10.9%), of the 320 patients, twenty three males and twelve females, died and accounting for an operative mortality rate of 10.94%. After adjusting for confounding variables, vital sign at presentation (systolic <90mmhg) (odds ratio [AOR] = 0.158, P = 0.002), admission to ICU ([AOR] = 0.075, P=0.03) and early discharge from Hospital before one week ([AOR] =11.8, P=0.000) were independent predictors of postoperative complications in an emergency laparotomy. II Except early discharge; other two variables are protective to post-operative complication this is due to patients with (shock, admission to ICU) died early before they develop post-operative complications. Patients who were discharged earlier than one week had more than eleven times chance of developing post-operative complication compared to late discharge. After adjusting for confounding variables, age more than 61 years (odds ratio [AOR] =20.280, P = 0.037, patient with comorbid illness (AOR =10.473, p=.016), vital sign at presentation (systolic <90mmhg) (odds ratio [AOR] =26.73, P = 0.001) and having complication post operatively (OR = 29.76, P = 0.00), were independent predictors of 30-day mortality in an emergency laparotomy. CONCLUSION AND RECOMMENDATION: Early discharge from Hospital result in higher post-operative complication in emergency laparatomy. Emergency laparotomy carries a high rate of mortality, 10.9 % overall, increasing to 28 % in those aged 61 years or older. Patients with emergency laparatomy should not be discharged early so as to prevent complication. Patients who are older more than 61 years, presented with shock and who has comorbid illness are at higher risk to die post operatively, so more needs to be done to improve outcomes, particularly in this group. This could involve early recognition of patients requiring emergency surgery, adequate preoperative resuscitation and proper post-operative care would help to reduce the observed high mortality. Patients who develop post op complication had high risk of mortality, so early diagnosis and treatment of complication should be done to reduce postoperative mortality.