Time to recovery and its predictors after thoracic surgery in selected government hospitals in Addis Ababa, Ethiopia 2024.

Abstract

ABSTRACT Back ground: Thoracic surgery is one of the most common surgical procedures performed on patients globally and locally. It requires substantial medical attention. It is the main cause of mortality and morbidity, with detrimental effects on longevity, healthcare costs, and quality of life. Developing countries are concerned about this as one of their main surgical issues. Thoracic surgery is common, and both its incidence and prevalence are rising in developing countries. Objectives: Assess time to recovery and its predictors after thoracic surgery in selected government hospitals in Addis Ababa, Ethiopia. Methods: A multi-institutional retrospective cohort study was conducted on 440 adult patients in selected government hospitals; from January 2021 up to December 2023. The collected data was entered into Epi-data version 4.4.3.1 and was exported to SPSS version 26, and coding, clean and analysis was done accordingly. Descriptive analysis frequencies with percentages and median survival times were used to characterize the study population. To compare the median time to post thoracotomy recovery between groups, the Kaplan-Meier survival plot together with the Log-rank test were used. The Cox proportional hazard survival model was used to identify significant predictors. All variable with a p ≤ 0.05 in the bivariable analysis was candidate variables to be included in a multivariable analysis. Cox proportional hazard model assumption was checked using a formal statistical test, the GLOBAL test. In the final model, hazard ratio with 95% confidence interval and p- value (< 0.05) was used to declare statistically significant predictors. Result: Of the 440 patients, 371 (84.3%) fully recovered, and the remaining 69 (15.6%) were censored. Among the censored observations, 62 (14.1%) have recovered from complications, and 7 (1.4%) have died. The overall median time to post-thoracotomy recovery was 10 days (95% CI: 9.31–10.69). Significant predictors of major complication, death and delayed recovery were decrease in younger age (AHR= 0.243, 95% CI=0.137, 0.430, P=0.000) and taking of TPVB during surgery (AHR= 2.324, 95% CI=1.719, 3.140, P=0.00). Other factors being (AHR=1.501, 95% CI=1.129, 1.994, P=0.005), open thoracotomy (AHR=0.252, 95% CI= 0.419, 0.425, P=0.000), smokers(AHR=0.462, 95% CI=0.263, 0.811, P=0.007), history of previous surgery(AHR= 0.575, 95% CI = 0.344, 0.962, P=0.035, experience IOC (AHR=0.348, 95% CI= 0.209, 0.580 P=0.00)and comorbidities (hypertension(AHR=0.129, 95% CI=0.070, 0.237, P=0.000, DM(AHR=0.129, 95% CI=0.070, 0.237, P=0.00, CVD(AHR=0.283, 95% CI=0.160, 0.503, P=0.000 and HIV(AHR=0.079, 95% CI=0.011, 0.574, P=0.012). Keywords: Post-thoracotomy outcomes, time to post-thoracotomy recovery, censor, Cox proportional Hazard survival model. Conclusion: The study population's post-thoracotomy morbidity and mortality are comparable to prior reports, and the median recovery time is within the expected range for a good outcome. As a result, risk mitigation during the perioperative period and close monitoring and management of high-risk patients during the postoperative period are crucial.