Short-term outcomes of laparotomy in the two teaching hospitals of gulu university, northern uganda

Amone, Derrick; Tr, Okello; Okot, Christopher; Dl, Kitara; Mugabi, P; Dm, Ogwang

doi:10.17352/2455-2283.000084

Cited by 13 publications

(12 citation statements)

References 23 publications

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“…A structured checklist prepared in English and adapted from (14,(27)(28)(29) was used to collect data. Data collectors had collected all the information from chart to the data abstraction format.…”

Section: Data Collection Tools and Proceduresmentioning

confidence: 99%

Magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary public hospitals, West Oromia, Ethiopia, 2022

Benti,

Tesgera,

Alemshet

2023

Preprint

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Introduction: Laparotomy surgery is an incision in the abdominal cavity to treat serious abdominal disease and save the patient's life. It is performed in both elective and emergency conditions and results in significant deaths in both developed and developing countries, including Ethiopia. Studies of in-hospital mortality among patients undergone laparotomy surgery and associated factors are limited. Objective: To assess the magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary hospitals, West Oromia, Ethiopia, 2022. Method: An institutional retrospective cross-sectional study was donefrom January 1, 2017 to December 31, 2021. Data were collected using systematic random sampling and basedstructured and pre-tested abstraction sheet from 548 patient chars and registries.Data were checked for completeness, consistency, coded, importedusing EPI data version 4.6, cleaned and analyzedusing SPSS version 25. Variables with p < 0.2 in bi-variable logistic regression analysis were included in themultivariate logistic regression analysis. The model fitness was checked by the Hosmer-Lemeshow test. Using the adjusted odds ratio with 95% CI and a p-value of 0.05, statistical significance was declared. Results: A total of 512 patient records were reviewed and the response rate was 93.43%. The overall in-hospital mortality rate was 7.42% [95% CI: 5.4-9.8]. American Anaesthesiology Association physiological status of patients ≥ III [AOR=7.64 (95% CI: 3.12-18.66)], systolic blood pressure <90 mmHg at admission [AOR=6.11 (95% CI: 1.98-18.80)], presence of preoperative sepsis [AOR= 3.54 (95% CI: 1.53-8.19)], Intensive care unit admission [AOR = 4.75 (95% CI: 1.50-14.96)], and hospital stay ≥14 days [(AOR = 6.76 (95% CI: 2.50-18.26)] were significantly associated with in-hospital mortality after laparotomy surgery. Concussion: In this study,overall in-hospital mortality was high. TheAmerican Society of Anaesthesiologists identifies the patient's physical condition early, requires appropriate intervention,and pays special attention to patients: low systolic blood pressure, preoperative sepsis, admission to the hospital, Intensive care unit and prolonged hospital stay, in order to improve patient outcomes after laparotomy surgery.

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Section: Data Collection Tools and Proceduresmentioning

confidence: 99%

Magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary public hospitals, West Oromia, Ethiopia, 2022

Benti,

Tesgera,

Alemshet

2023

Preprint

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“…In Uganda, surgical site infection (20%) and mortality within 30 days (15.6%) are among the most common post-laparotomy complications (7), and in this setting, emergency laparotomy constitutes 67.1% of laparotomies (8). It is worth noting that emergency laparotomies are frequently conducted with little patient preparation, hence often resulting in more postoperative complications than elective laparotomy (33.7% vs 14.2%, p<0.05) (9).…”

Section: Introductionmentioning

confidence: 99%

Effect of perioperative blood transfusion on complications following emergency non-trauma laparotomy in Mulago hospital: A prospective cohort study.

Egbe,

Mbiine,

Okello

et al. 2024

Preprint

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Background: Blood transfusion may be required in the management of patients undergoing emergency non-trauma laparotomy. However, several retrospective cohort studies involving patients undergoing laparotomy for benign and malignant indications have identified blood transfusion as a significant predictor of postoperative infections and mortality. Still, no study has explored such an association in our setting. We aimed to determine the effect of perioperative blood transfusion on the 30-day risk of surgical site infections and mortality among patients undergoing emergency non-trauma laparotomy in a large urban tertiary hospital in a low-resource setting. Methods: In this prospective cohort study, we recruited 160 adult patients admitted to the general surgery wards 48 hours after emergency non-trauma laparotomy. We grouped them based on transfusion exposure and non-exposure. Independent variables, including perioperative blood transfusion and confounders, were recorded on entry, while dependent variables, including the presence or absence of surgical site infection and mortality, were obtained over a 30-day follow-up period. Data were analysed using EPI INFO version 7, SPSS version 29 & Stata version 14. Results: All 160 participants recruited, 28 (17.5%) transfused (exposed) and 132 (82.5%) not transfused (non-exposed), were included in the final analysis. Transfusion exposure (RR, 7.81; 95% CI, 2.58 – 23.63; p=0.0003) and preoperative leucocytosis/leucopoenia (RR, 2.19; 95% CI, 1.04 – 4.65; p=0.040) were identified as independent risk factors for SSI after multivariate logistic regression analysis adjusted for confounders including preoperative anaemia, young-to-middle-aged adults, cloudy/purulent/feculent exudate, gut perforation diagnosis, female sex, and registrar-led surgical team. Furthermore, transfusion exposure (HR, 3.36; 95% CI, 1.11 – 10.25; p=0.033) and old age (HR, 5.50; 95% CI, 1.67 – 18.11; p=0.005) were identified as independent risk factors for 30-day mortality after multivariate Cox regression analysis adjusted for confounders including high ASA score, immunodeficiency, cloudy/purulent/feculent exudate, bowel obstruction and high-risk procedure for bowel leak. Conclusion: Among patients undergoing emergency non-trauma laparotomy, perioperative blood transfusion compared to no perioperative blood transfusion increased the risk of 30-day SSI by 7.81 and the 30-day mortality risk by 3.36. A restrictive transfusion strategy and a more extensive multicentre prospective cohort study are recommended.

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“…Secondary peritonitis has also been reported to be the second leading cause of sepsis worldwide (3,10). In Africa the proportion of secondary peritonitis has been reported to vary depending on the region with Alelign (10) reporting a prevalence of 19.1% in Ethiopia, Seni et al (12) 23.7% in Tanzania and Amone et al (13) 17.1% in Uganda.…”

Section: Introductionmentioning

confidence: 99%

Antibacterial susceptibility patterns and factors associated with secondary peritonitis among patients with acute abdomen: a cross-sectional study

Godefroy

Muhumuza

Molen

et al. 2023

Preprint

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Introduction: Secondary peritonitis is the second leading cause of sepsis worldwide. Drug-resistance to peritoneal cavity bacterial infection remains a public health threat especially in resource limited settings of Africa including Uganda. This study was aimed at determining the antibacterial susceptibility patterns and factors associated with secondary peritonitis among patients with acute abdomen who underwent surgery at a Regional Referral Hospital in Uganda. Methods: This was a cross sectional study conducted at Hoima Regional Referral Hospital (HRRH) that enrolled 126 patients with acute abdomen. After laparotomy, clinical samples were aseptically collected from patients with secondary peritonitis for culture and sensitivity using standard Microbiological methods. Binary logistic regression was used to identify factors associated with secondary peritonitis among patients with acute abdomen. Results: Majority of the patients were males (61.9%) with a mean age of 37.9(SD +/- 21.8). Secondary peritonitis was found in 57(45.2%) of the patients. Gram-negative bacteria were the most commonly isolated organisms with Escherichia coli (35.8%) and Klebsiella spp (17.0%) predominating. Imipenem 88.8%(8/9), Amikacin 88.8%(8/9), Ciprofloxacin 44.4%(4/9) and Gentamicin 44.4%(4/9) demonstrated sensitivity to the different isolated organism at varying degrees. Being a male (AOR = 3.658; 95% CI = 1.570–8.519, p = 0.003) and presenting 3 days after onset of symptoms (AOR = 2.957; 95%CI = 1.232–7.099, p = 0.015) were independently associated with secondary peritonitis. Conclusion Imipenem, Amikacin, Ciprofloxacin and Gentamicin should be considered for empirical therapy in cases of secondary peritonitis. Patients, more especially males with abdominal pain should be encouraged to present early to the hospital in order to minimise progression to secondary peritonitis.

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Short-term outcomes of laparotomy in the two teaching hospitals of gulu university, northern uganda

Cited by 13 publications

References 23 publications

Magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary public hospitals, West Oromia, Ethiopia, 2022

Magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary public hospitals, West Oromia, Ethiopia, 2022

Effect of perioperative blood transfusion on complications following emergency non-trauma laparotomy in Mulago hospital: A prospective cohort study.

Antibacterial susceptibility patterns and factors associated with secondary peritonitis among patients with acute abdomen: a cross-sectional study

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