Factors associated with adverse events after emergency laparotomy in Cape Town, South Africa: identifying opportunities for quality improvement

Spence, Richard T.; Hampton, Mark; Pluke, Kent; Kahn, Miriam; Chinyepi, Nkhabe; Elmusbahi, Mohamed; Wyngaard, Tirsa van; Panieri, Eugenio

doi:10.1016/j.jss.2016.08.025

Cited by 11 publications

(10 citation statements)

References 21 publications

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“…This study showed that the overall incidence of postoperative complication was (39.3%) (75/191), which was almost relatively comparable to the study done in India (36.6%) and Pakistan (33.3%) 17 , 18 . However, it is higher than the study done in South Africa (15.7%) 19 . An obvious explanation for divergent complication rates among studies is that complications are defined in many different ways.…”

Section: Discussioncontrasting

confidence: 65%

Perioperative mortality and its predictors among patients undergoing emergency laparotomy at selected southern Ethiopian governmental hospitals, 2022: a multicenter prospective cohort study

Hailu

Ayinie

Amsalu

et al. 2023

Annals of Medicine &Amp; Surgery

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Background: Globally, emergency laparotomy is a frequently performed type of surgery with high morbidity and mortality rates, even in the best healthcare systems. There is limited knowledge regarding the outcome of emergency laparotomy performed in Ethiopia. Objective: To assess perioperative mortality and its predictors among patients undergoing emergency laparotomy at selected southern Ethiopian governmental hospitals. Methods: A multicenter prospective cohort study was conducted, and data were collected at selected hospitals after obtaining ethical approval from the Institutional Review Board. Data were analyzed using SPSS version 26. Results: The rate of postoperative complications after emergency laparotomy surgery was 39.3%, with an in-hospital mortality rate of 8.4% and a length of hospital stay of 9±6.5 days. The predictors of postoperative mortality were the age of the patient greater than 65 [adjusted odds ratio (AOR)=8.46, 95% CI=1.3–57.1], presence of intraoperative complications (AOR=7.26, 95% CI=1.3–41.3), and postoperative ICU admission (AOR=8.5, 95% CI=1.5–49.6). Conclusion: Our study revealed a significant level of postoperative complications and in-hospital mortality. The identified predictors should be sorted and applied to the preoperative optimization, risk assessment, and standardization of effective postoperative care following emergency laparotomy.

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Section: Discussioncontrasting

confidence: 65%

Perioperative mortality and its predictors among patients undergoing emergency laparotomy at selected southern Ethiopian governmental hospitals, 2022: a multicenter prospective cohort study

Hailu

Ayinie

Amsalu

et al. 2023

Annals of Medicine &Amp; Surgery

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“…Emergency laparotomy for non‐trauma in South Africa is associated with significant morbidity and mortality. This is similar to the situation reported from HIC's [4, 14]. The patient age is significantly younger than that reported from HIC's although advancing age correlates with an increasing rate of AE's.…”

Section: Discussionsupporting

confidence: 87%

Health‐Related Behaviours, HIV and Active Tuberculosis are Associated with Perioperative Adverse Events Following Emergency Laparotomy at a Tertiary Surgical Service in KwaZulu‐Natal, South Africa

2021

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Introduction This project aims to define the common comorbidities associated with patients undergoing emergency laparotomy in South Africa, to review the impact of these comorbidities on outcome and to attempt to model these various factors. Method A retrospective review of all patients undergoing emergency laparotomy for an emergency general surgical condition was performed from the prospectively entered Hybrid Electronic Medical Registry (HEMR). Univariate and multiple logistic regression analysis was performed to establish associations and independent risk factors for developing an adverse event. Results Over a six‐year time period, a total of 1464 patients underwent emergency laparotomy. The median age was 34 years. Males constituted 58.8% (861) of the patients and 754 patients (51.5%) experienced at least one adverse event. The mortality rate was 12 percent. Comorbidities and social factors were documented in 912 patients (62.3%). The rate of adverse events among patients with comorbidities was 59% (538). Patients without comorbidities or significant social factors had an adverse event rate of 39.1% (216). This difference was statistically significant (p < 0.001). The most frequent comorbidity in our sample was HIV, followed by hypertension, underlying malignancy, diabetes mellitus, active TB and cardiovascular disease. Conclusion Emergency laparotomy in South Africa is associated with significant morbidity and mortality. The patients are younger than in high‐income countries. Diabetes mellitus, hypertension, HIV and active TB are associated with the development of an AE.

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“…EAS outcomes depend on patient and surgical system factors. Multicentre, national and international studies on EAS outcomes have been published from the UK,7 8 Denmark,9–11 Australia,12 13 the USA,7 14 Canada1 and South Africa 15. These studies promoted safer EAS care through the introduction of clinical pathways and sustainable national audits.…”

Section: Introductionmentioning

confidence: 99%

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

et al. 2019

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ObjectivesEmergency abdominal surgery (EAS) refers to high-risk intra-abdominal surgical procedures undertaken for acute gastrointestinal pathology. The relationship between hospital or surgeon volume and mortality of patients undergoing EAS is poorly understood. This study examined this relationship at the national level.DesignThis is a national population-based study using a full administrative inpatient dataset (National Quality Assurance Improvement System) from publicly funded hospitals in Ireland.Setting24 public hospitals providing EAS services.Participants and InterventionsPatients undergoing EAS as identified by primary procedure codes during the period 2014–2018.Main outcome measuresThe main outcome measure was adjusted in-hospital mortality following EAS in publicly funded Irish hospitals. Mortality rates were adjusted for sex, age, admission source, Charlson Comorbidity Index, procedure complexity, organ system and primary diagnosis. Differences in overall, 7-day and 30-day in-hospital mortality for hospitals with low (<250), medium (250–449) and high (450+) volume and surgical teams with low (<30), medium (30–59) and high (60+) volume during the study period were also estimated.ResultsThe study included 10 344 EAS episodes. 798 in-hospital deaths occurred, giving an overall in-hospital mortality rate of 77 per 1000 episodes. There was no statistically significant difference in adjusted mortality rate between low and high volume hospitals. Low volume surgical teams had a higher adjusted mortality rate (85.4 deaths/1000 episodes) compared with high volume teams (54.7 deaths/1000 episodes), a difference that persisted among low volume surgeons practising in high volume hospitals.ConclusionPatients undergoing EAS managed by high volume surgeons have better survival outcomes. These findings contribute to the ongoing discussion regarding configuration of emergency surgery services and emphasise the need for effective clinical governance regarding observed variation in outcomes within and between institutions.

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Factors associated with adverse events after emergency laparotomy in Cape Town, South Africa: identifying opportunities for quality improvement

Cited by 11 publications

References 21 publications

Perioperative mortality and its predictors among patients undergoing emergency laparotomy at selected southern Ethiopian governmental hospitals, 2022: a multicenter prospective cohort study

Perioperative mortality and its predictors among patients undergoing emergency laparotomy at selected southern Ethiopian governmental hospitals, 2022: a multicenter prospective cohort study

Health‐Related Behaviours, HIV and Active Tuberculosis are Associated with Perioperative Adverse Events Following Emergency Laparotomy at a Tertiary Surgical Service in KwaZulu‐Natal, South Africa

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

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