Changing Epidemiology of Intestinal Obstruction in Ghana: Signs of Increasing Surgical Capacity and an Aging Population

Abstract

Introduction: This study aimed to describe the epidemiology and outcomes of intestinal obstruction at a tertiary hospital in Ghana over time. Methods: Records of all patients admitted to a tertiary hospital from 2007 to 2011 with intestinal obstruction were identified using ICD-9 codes. Sociodemographic and clinical data were compared to a previously published series of intestinal obstructions from 1998 to 2003. Factors contributing to longer than expected hospital stays and death were further examined. Results: Of the 230 records reviewed, 108 patients (47%) had obstructions due to adhesions, 50 (21%) had volvulus, 22 (7%) had an ileus from perforation and 14 (6%) had intussusception. Hernia fell from the 1st to the 8th most common cause of obstruction. Patients with intestinal obstruction were older in 2007-2011 compared to those presenting between 1998 and 2003 (p < 0.001); conditions associated with older age (e.g. volvulus and neoplasia) were more frequently encountered (p < 0.001). Age over 50 years was strong factor of in-hospital death (adjusted OR 14.2, 95% CI 1.41-142.95). Conclusion: Efforts to reduce hernia backlog and expand the surgical workforce may have had an effect on intestinal obstruction epidemiology in Ghana. Increasing aging-related pathology and a higher risk of death in elderly patients suggest that improvement in geriatric surgical care is urgently needed.

Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana

“…Interestingly, in the more urban capital of Accra, the rates of obstruction due to hernia have dramatically decreased such that hernias are now the eighth most common reason for obstruction. This has been attributed to an increase in the surgical workforce and a conscious effort to reduce hernia "backlog" in the capital [13]. Unfortunately, the changes in urban Ghana do not yet appear to have reached rural Ghana where emergent and urgent operations for hernias likely increase POMR.…”

Demographics and Mortality Rates of Surgical Emergencies Treated at the Casualty Operation Theater: A Six-month Retrospective Analysis

“…Intestinal obstruction on the other hand carried significant mortality. Increasing age (especially in the geriatric population) has been implicated with higher mortality rates [9]. The elderly also have a higher prevalence of comorbidity.…”

Etiologic Spectrum of Intestinal Obstruction in Ningxia District: A Retrospective Analysis of 4908 Cases in a 10-Year Period

“…As the socioeconomic and medical insurance increased, variation exists in the etiology of intestinal obstruction in terms of geographic distribution. In western countries, the main constitution of IO is adhesive obstruction and gastrointestinal tumors [12], while in some developing even poor countries, inguinal hernia still takes up the majority of the etiology [13]. The study showed that intestinal obstruction caused by adhesions and tumors increased in Ningxia during a 10-year period, while hernias causing intestinal obstruction decreased by year.…”