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

Hailu, Seyoum; Ayinie, Animut; Amsalu, Hunde; Hailu, Sileshi; Tadesse, Muhiddin; Mamo, Temesgen; Sagni, Yonas; Mekonen, Semagn; Jemal, Bedru

doi:10.1097/ms9.0000000000000437

Cited by 3 publications

(4 citation statements)

References 29 publications

(32 reference statements)

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“…This study revealed that patients who were hypotensive at presentation were 3.87 times more likely to develop perioperative adverse outcomes. These results are consistent with those of previous studies conducted in Ethiopia, Tanzania, and the U.S. 7 , 10 , 32 , 33 Optimization of blood pressure during the perioperative period has been shown to enhance surgical outcomes. According to a systematic review, hypotension increases the likelihood of adverse post-operative outcomes.…”

Section: Discussionsupporting

confidence: 92%

“…This study found that patients with a higher ASA status (ASA II–IV) were 2.37 times more likely to develop perioperative adverse outcomes [AOR: 2.37 (95% CI: (1.05, 5.34))]. This finding was consistent with those of a multicenter study conducted in southern Ethiopia, 32 Cologne (Germany), 45 and Wales (United Kingdom), 46 which demonstrated that the risk of developing post-operative complications was highly influenced by a higher ASA category. This may be attributed to the patients’ poor physical condition and debilitating comorbidities during the pre-operative period.…”

Section: Discussionsupporting

confidence: 90%

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Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study

Deresse,

Tesfahun,

Gebreegziabher

et al. 2023

OAEM

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Background Acute sigmoid volvulus is a surgical emergency with closed-loop obstruction of the colon that often requires emergency laparotomy, which is associated with a multitude of post-operative complications. Although sigmoid volvulus is the main cause of intestinal obstruction in Ethiopia, local studies of its management outcomes are limited. Objective To assess the magnitude and predictors of adverse perioperative outcomes of emergency laparotomy for acute sigmoid volvulus in the Debre Markos Comprehensive Specialized Hospital (DMCSH), Amhara region, Ethiopia in 2023. Methods This was a retrospective follow-up study. Descriptive statistics were used to measure perioperative outcomes and other study variables. Bivariable and multivariable logistic regression models were used to identify the predictors of adverse surgical outcomes. Associations were considered significant at p < 0.05 (95% confidence interval). Results In total, 170 study participants were enrolled, with a response rate of 91.4%. Forty-nine patients (28.8%) developed perioperative adverse outcomes. Pneumonia (29 patients, 28.1%), surgical site infection (19 patients, 18.4%), and wound dehiscence (10 patients, 9.7%) were the most common complications. Pre-operative shock [AOR: 3.87 (95% CI: (1.22, 12.28))], pus or fecal matter contamination of the peritoneum [AOR: 4.43 (95% CI: (1.35, 14.47)], and a higher American Society of Anesthesiologists (ASA) score [AOR: 2.37 (95% CI: (1.05, 5.34))] were identified as predictors of perioperative adverse events. Conclusion The perioperative adverse outcomes in this study were higher than those reported in Ethiopian national and global reports following emergency laparotomies. Hypotension at presentation, pus and/or fecal matter contamination of the peritoneum, and higher ASA scores are strong predictors of increased perioperative adverse outcomes. Therefore, healthcare providers and institutions involved in the delivery of emergency surgical care should emphasize the importance of early surgical intervention, adequate resuscitation, and patient monitoring to improve perioperative outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study

Deresse,

Tesfahun,

Gebreegziabher

et al. 2023

OAEM

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“…Most of the admissions in this study, (41 of 45), were with ASA status IE & IIE which contrasts with nationwide databasis in Japan [ 45 ]. Similar studies from Ethiopia and others [ 38 , 46 , 47 ] reported admission to intensive care units to be associated with higher mortality. However, in these studies, 23.8% of patients were admitted at any time to the ICU postoperatively and the 30-day mortality seen among ICU patients was 37.9% which is proportionally higher than found in this study (11.65 and 36.6% respectively).…”

Section: Discussionsupporting

confidence: 80%

Perioperative mortality rate and its predictors after emergency laparatomy at Debre Markos comprehensive specialized hospital, Northwest Ethiopia: 2023: retrospective follow-up study

Dessalegn,

Negesse,

Deresse

et al. 2024

BMC Surg

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Background Emergency laparatomy is abdominal surgery associated with a high rate of mortality. There are few reports on rates and predictors of postoperative mortality, whereas disease related or time specific studies are limited. Understanding the rate and predictors of mortality in the first 30 days (perioperative period) is important for evidence based decision and counseling of patients. This study aimed to estimate the perioperative mortality rate and its predictors after emergency laparatomy at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia, 2023. Methods This was a Hospital-based retrospective follow-up study conducted at Debre Markos Comprehensive Specialized Hospital in Ethiopia among patients who had undergone emergency laparatomy between January 1, 2019 and December 31, 2022. Sample of 418 emergency laparatomy patients selected with simple random sampling technique were studied. The data were extracted from March 15, 2023 to April 1, 2023 using a data extraction tool, cleaned, and entered into Epi-Data software version 3.1 before being exported to STATA software version 14.1 for analysis. Predictor variables with P value < 0.05 in multivariable Cox regression were reported. Results Data of 386 study participants (92.3% complete charts) were analyzed. The median survival time was 18 days [IQR: (14, 29)]. The overall perioperative mortality rate in the cohort during the 2978 person-days of observations was 25.5 per 1000 person-days of follow-up [95% CI: (20.4, 30.9))]. Preoperative need for vasopressor [AHR: 1.8 (95% CI: (1.11, 2.98))], admission to intensive care unit [AHR: 2.0 (95% CI: (1.23, 3.49))], longer than three days of symptoms [AHR: 2.2 (95% CI: (1.15, 4.02))] and preoperative sepsis [AHR: 1.8 (95% CI: (1.05, 3.17))] were identified statistically significant predictors of perioperative mortality after emergency laparatomy. Conclusions The perioperative mortality rate is high. Preoperative need for vasopressors, admission to intensive care unit, longer than three days of symptoms and preoperative sepsis were predictors of increased perioperative mortality rate.

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“…Patients with severe abdominal sepsis often require an emergency laparotomy, which is associated with higher mortality and morbidity compared to less invasive procedures (Fig. 2 ) [ 12 , 59 , 69 , 90 , 136 , 154 , 162 ]. Possible reasons for poorer outcomes include the trauma of surgery itself amplifying immune cell activation, increasing inflammation, coagulopathy and MODS [ 39 , 41 ].…”

Section: Pathophysiology From a System’s Perspectivementioning

confidence: 99%

Revolution in sepsis: a symptoms-based to a systems-based approach?

Dobson,

Letson,

Morris

2024

J Biomed Sci

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Severe infection and sepsis are medical emergencies. High morbidity and mortality are linked to CNS dysfunction, excessive inflammation, immune compromise, coagulopathy and multiple organ dysfunction. Males appear to have a higher risk of mortality than females. Currently, there are few or no effective drug therapies to protect the brain, maintain the blood brain barrier, resolve excessive inflammation and reduce secondary injury in other vital organs. We propose a major reason for lack of progress is a consequence of the treat-as-you-go, single-nodal target approach, rather than a more integrated, systems-based approach. A new revolution is required to better understand how the body responds to an infection, identify new markers to detect its progression and discover new system-acting drugs to treat it. In this review, we present a brief history of sepsis followed by its pathophysiology from a systems’ perspective and future opportunities. We argue that targeting the body’s early immune-driven CNS-response may improve patient outcomes. If the barrage of PAMPs and DAMPs can be reduced early, we propose the multiple CNS-organ circuits (or axes) will be preserved and secondary injury will be reduced. We have been developing a systems-based, small-volume, fluid therapy comprising adenosine, lidocaine and magnesium (ALM) to treat sepsis and endotoxemia. Our early studies indicate that ALM therapy shifts the CNS from sympathetic to parasympathetic dominance, maintains cardiovascular-endothelial glycocalyx coupling, reduces inflammation, corrects coagulopathy, and maintains tissue O2 supply. Future research will investigate the potential translation to humans.

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

Cited by 3 publications

References 29 publications

Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study

Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study

Perioperative mortality rate and its predictors after emergency laparatomy at Debre Markos comprehensive specialized hospital, Northwest Ethiopia: 2023: retrospective follow-up study

Revolution in sepsis: a symptoms-based to a systems-based approach?

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