Implementation of a Surgical Critical Care Service Reduces Failure to Rescue in Emergency Gastrointestinal Surgery in Rural Kenya

Many, Heath R.; Otoki, Kemunto; Parker, Andrea S.; Parker, Robert K.

doi:10.1097/sla.0000000000005215

Cited by 7 publications

(2 citation statements)

References 37 publications

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“…Due to the venous outflow obstruction of intestinal volvulus, this approach allows the bowel to demarcate for definitive resection at the second operation. This approach has been facilitated by the growing ability to care for critically-ill patients and the establishment of critical care units in our hospital [ 34 ]. However, many patients still die of multi-organ failure secondary to refractory septic shock.…”

Section: Discussionmentioning

confidence: 99%

Cecal volvulus in rural Kenya: delayed presentation contributes to high mortality

Sylvester

Ooko²,

Mwachiro

et al. 2021

BMC Surg

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Background Cecal volvulus, which is a torsion involving the cecum, terminal ileum, and ascending colon around its own mesentery, results in a closed-loop obstruction. It is a rare reported cause of adult intestinal obstruction. This study aimed to review the clinical presentation, management, and outcomes at a rural, resource-limited referral center. Methods We performed a retrospective review of all patients with a diagnosis of cecal volvulus between January 1st, 2009 and December 31st, 2019 at Tenwek Hospital in Bomet, Kenya. The outcome of survival was compared by the time to presentation. Mortality was also compared with prior reports of intestinal obstruction at our institution. Results Thirteen patients were identified with a mean age of 52 years and a mean symptom duration of 5 days. All patients presented with abdominal pain and distension. Seven patients (54%) presented with perforation, gangrene, or gross peritoneal contamination. Identified risk factors were Ladds bands with malrotation, adhesions, and a sigmoid tumor. Procedures included primary resection and anastomosis (7), damage control (3) with anastomosis on second-look in 2 of these, simple surgical detorsion (1), and surgical detorsion and cecopexy (2). There were four mortalities (31%), of which all had delayed presentation with perforation and fecal contamination. Delays to presentation were associated with mortality (p = 0.03). Cecal volvulus resulted in increased perioperative mortality compared to all intestinal obstructions presenting to the institution (p < 0.0001). Conclusions Cecal volvulus carries a high risk of mortality. A high index of suspicion and early consideration in the differential diagnosis of intestinal obstruction should be considered to reduce the mortality associated with the delay in preoperative diagnosis.

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Section: Discussionmentioning

confidence: 99%

Cecal volvulus in rural Kenya: delayed presentation contributes to high mortality

Sylvester

Ooko²,

Mwachiro

et al. 2021

BMC Surg

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“…Condition specific Gastroschisis care protocol for neonatal surgery 53 Gastrointestinal surgical critical care service for emergency patients 100 2 Enhance recovery after surgery Elective surgery 101 Emergency surgery 60 2 Hospital electronic record database Surgical adverse events/surgical in-patient data recording 61 62 Multicentre cloud-based perioperative register 50 3…”

Section: Intervention Characteristicsmentioning

confidence: 99%

Improving quality of surgical and anaesthesia care in sub-Saharan Africa: a systematic review of hospital-based quality improvement interventions

Brima

Morhason-Bello

Charles³

et al. 2022

BMJ Open

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ObjectivesTo systematically review existing literature on hospital-based quality improvement studies in sub-Saharan Africa that aim to improve surgical and anaesthesia care, capturing clinical, process and implementation outcomes in order to evaluate the impact of the intervention and implementation learning.DesignWe conducted a systematic literature review and narrative synthesis.SettingLiterature on hospital-based quality improvement studies in sub-Saharan Africa reviewed until 31 December 2021.ParticipantsMEDLINE, EMBASE, Global Health, CINAHL, Web of Science databases and grey literature were searched.InterventionWe extracted data on intervention characteristics and how the intervention was delivered and evaluated.Primary and secondary outcome measuresImportantly, we assessed whether clinical, process and implementation outcomes were collected and separately categorised the outcomes under the Institute of Medicine quality domains. Risk of bias was not assessed.ResultsOf 1573 articles identified, 49 were included from 17/48 sub-Saharan African countries, 16 of which were low-income or lower middle-income countries. Almost two-thirds of the studies took place in East Africa (31/49, 63.2%). The most common intervention focus was reduction of surgical site infection (12/49, 24.5%) and use of a surgical safety checklist (14/49, 28.6%). Use of implementation and quality improvement science methods were rare. Over half the studies measured clinical outcomes (29/49, 59.2%), with the most commonly reported ones being perioperative mortality (13/29, 44.8%) and surgical site infection rate (14/29, 48.3%). Process and implementation outcomes were reported in over two thirds of the studies (34/49, 69.4% and 35, 71.4%, respectively). The most studied quality domain was safety (44/49, 89.8%), with efficiency (4/49, 8.2%) and equitability (2/49, 4.1%) the least studied domains.ConclusionsThere are few hospital-based studies that focus on improving the quality of surgical and anaesthesia care in sub-Saharan Africa. Use of implementation and quality improvement methodologies remain low, and some quality domains are neglected.PROSPERO registration numberCRD42019125570

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Interventions for improving critical care in low- and middle-income countries: a systematic review

Wagstaff,

Arfin,

Korver

et al. 2024

Intensive Care Med

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Implementation of a Surgical Critical Care Service Reduces Failure to Rescue in Emergency Gastrointestinal Surgery in Rural Kenya

Cited by 7 publications

References 37 publications

Cecal volvulus in rural Kenya: delayed presentation contributes to high mortality

Cecal volvulus in rural Kenya: delayed presentation contributes to high mortality

Improving quality of surgical and anaesthesia care in sub-Saharan Africa: a systematic review of hospital-based quality improvement interventions

Interventions for improving critical care in low- and middle-income countries: a systematic review

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