Indications and Outcomes for Non‐Trauma Emergency Laparotomy: A Comparison of Rwanda, South Africa, and the USA

Abstract

Background Emergency conditions requiring exploratory laparotomy (EL) can be challenging. The objective of this study is to describe indications, outcomes, and risk factors for perioperative mortality (POMR) after non‐trauma EL. Methods This was a prospective study of patients undergoing non‐trauma EL at four hospitals in Rwanda, South Africa, and the USA. Multivariate logistic regression was used to determine factors associated with POMR. Results Over one year, there were 632 EL with the most common indications appendicitis (n = 133, 21%), peptic ulcer disease (PUD) (n = 101, 16%), and hernia (n = 74, 12%). In Rwanda, the most common indications were appendicitis (n = 41, 19%) and hernia (n = 37, 17%); in South Africa appendicitis (n = 91, 28%) and PUD (n = 60, 19%); and in the USA, PUD (n = 16, 19%) and adhesions from small bowel obstruction (n = 16, 19%). POMR was 11%, with no difference between countries (Rwanda 7%, South Africa 12%, US 16%, p = 0.173). Risk factors associated with increased odds of POMR included typhoid intestinal perforation (adjusted odds ratio (aOR): 16.48; 95% confidence interval (CI): 4.31, 62.98; p value < 0.001), mesenteric ischemia (aOR: 13.77, 95% CI: 4.21, 45.08, p value < 0.001), cancer (aOR: 5.84, 95% CI: 2.43, 14.05, p value < 0.001), other diagnoses (aOR: 3.97, 95% CI: 3.03, 5.20, p value < 0.001), high ASA score (score ≥ 3) (aOR: 3.95, 95% CI: 3.03, 5.15, p value < 0.001), peptic ulcer disease (aOR: 2.82, 95% CI: 1.64, 4.85, p value < 0.001), age > 60 years (aOR: 2.32, 95% CI: 1.41, 3.83, p value = 0.001), and ICU admission (aOR: 2.23, 95% CI: 1.24, 3.99, p value = 0.007). Surgery in the US was associated with decreased odds of POMR (aOR: 0.41, 95% CI: 0.21, 0.80, p value = 0.009). Conclusions Indications for EL vary between countries and POMR is high. Differences in mortality were associated with patient and disease characteristics with certain diagnoses associated with increased risk of mortality. Understanding the risk factors and outcomes for patients with EL can assist providers in judicious patient selection, both for patient counselling and resource allocation.

Spectrum, Management, and Outcomes of Abdominal Surgical Emergencies at a Referral Hospital in North West Cameroon

“…Male predominance (male to female ratio = 1.4:1) was observed in this study which is in agreement with other studies in Africa, and even in the developed world [12,13,18,19]. The mean age was 47.4 years which is comparable with findings in South Africa reported by Rickard et al [8], in the USA reported by Purcell et al in Malawi [16]. However, this age is much older than findings from other studies in Africa [10,11,20].…”

“…The indications and outcomes of emergency abdominal surgery vary within different settings from high, middle to low-income countries [8]. A study in Russia revealed acute appendicitis, acute cholecystitis, and acute pancreatitis as the most common abdominal surgical emergencies [9].…”

“…A study in Russia revealed acute appendicitis, acute cholecystitis, and acute pancreatitis as the most common abdominal surgical emergencies [9]. A similar study in the USA, showed peptic ulcers and small bowel obstruction due to adhesions as the most common indications for emergency abdominal surgery [8]. In Africa, a 2-year study carried out in Ethiopia showed that intestinal obstruction, acute appendicitis, and bowel perforation were the leading causes of abdominal surgical emergency admissions [10].…”

“…Management of surgical emergencies remains a challenge in resource limited settings because delayed presentation of patients requiring surgery is common, which is mainly due to the transfer of patients between facilities among other factors [13,14]. Emergency abdominal surgery is generally associated with a high post-operative mortality [2,5,8,13]. The United Kingdom (UK) Emergency Laparotomy Network and the American College of Surgeons National Surgical Quality Improvement Program reported 30-day mortality after emergency abdominal surgeries as 14.9% and 14%, respectively [13,15].…”

Assessment of the Use of Spinal Anesthesia for laparotomy: A Survey among French-speaking anesthetists

“…Around 175,000 laparotomies are performed annually in the USA and around 30,000 to 50,000 emergency laparotomies are performed annually in the UK with a variety of surgical etiologies 4,5 . The laparotomy is also a frequent MP-2023-792 intervention in limited resources countries in sub-Saharan Africa, where more than half of the surgical procedures performed are emergency laparotomies with high perioperative mortality rates 6 . More often laparotomy is the only way to determine the underlying pathology, the anatomical site of the perforation and eliminate foci of infection.…”