BACKGROUND: Few studies discuss causes and outcomes of peritonitis in low-income settings. This study describes epidemiology of patients with peritonitis at a Rwandan referral hospital. Identification of risk factors associated with mortality and unplanned reoperation could improve management of peritonitis. METHODS: Data were collected on demographics, clinical presentation, operative findings, and outcomes for all patients with peritonitis. Multivariate regression analysis identified factors associated with in-hospital mortality and unplanned reoperation. RESULTS: A total of 280 patients presented with peritonitis over a 6-month period. Causes of peritonitis were complications of intestinal obstruction (39%) and appendicitis (17%). Thirty-six (13%) patients required unplanned reoperation, and in-hospital mortality was 17%. Factors associated with increased odds of in-hospital mortality were unplanned reoperation (adjusted odds ratio 34.12), vasopressor use (adjusted odds ratio 24.91), abnormal white blood cell count (adjusted odds ratio 12.6), intensive care unit admission (adjusted odds ratio 9.06), and American Society of Anesthesiologist score ≥3 (adjusted odds ratio 7.80). Factors associated with increased odds of unplanned reoperation included typhoid perforation (adjusted odds ratio 5.92) and hypoxia on admission (adjusted odds ratio 3.82). CONCLUSION: Peritonitis in Rwanda presents with high morbidity and mortality. Minimizing delays in care is important, as many patients with intestinal obstruction present with features of peritonitis. A better understanding of patient care and management prior to arrival at the referral hospital is needed to identify areas for improvement at the health center and district hospital.
BACKGROUND: Few studies discuss causes and outcomes of peritonitis in low-income settings. This study describes epidemiology of patients with peritonitis at a Rwandan referral hospital. Identification of risk factors associated with mortality and unplanned reoperation could improve management of peritonitis. METHODS: Data were collected on demographics, clinical presentation, operative findings, and outcomes for all patients with peritonitis. Multivariate regression analysis identified factors associated with in-hospital mortality and unplanned reoperation. RESULTS: A total of 280 patients presented with peritonitis over a 6-month period. Causes of peritonitis were complications of intestinal obstruction (39%) and appendicitis (17%). Thirty-six (13%) patients required unplanned reoperation, and in-hospital mortality was 17%. Factors associated with increased odds of in-hospital mortality were unplanned reoperation (adjusted odds ratio 34.12), vasopressor use (adjusted odds ratio 24.91), abnormal white blood cell count (adjusted odds ratio 12.6), intensive care unit admission (adjusted odds ratio 9.06), and American Society of Anesthesiologist score ≥3 (adjusted odds ratio 7.80). Factors associated with increased odds of unplanned reoperation included typhoid perforation (adjusted odds ratio 5.92) and hypoxia on admission (adjusted odds ratio 3.82). CONCLUSION:Peritonitis in Rwanda presents with high morbidity and mortality. Minimizing delays in care is important, as many patients with intestinal obstruction present with features of peritonitis. A better understanding of patient care and management prior to arrival at the referral hospital is needed to identify areas for improvement at the health center and district hospital.
Authors: Jennifer Rickard; Christian Ngarambe; Leonard Ndayizeye; Blair Smart; Robert Riviello; Jean Paul Majyambere Journal: World J Surg Date: 2018-10 Impact factor: 3.352
Authors: Corrado Cancedda; Phil Cotton; Joseph Shema; Stephen Rulisa; Robert Riviello; Lisa V Adams; Paul E Farmer; Jeanne N Kagwiza; Patrick Kyamanywa; Donatilla Mukamana; Chrispinus Mumena; David K Tumusiime; Lydie Mukashyaka; Esperance Ndenga; Theogene Twagirumugabe; Kaitesi B Mukara; Vincent Dusabejambo; Timothy D Walker; Emmy Nkusi; Lisa Bazzett-Matabele; Alex Butera; Belson Rugwizangoga; Jean Claude Kabayiza; Simon Kanyandekwe; Louise Kalisa; Faustin Ntirenganya; Jeffrey Dixson; Tanya Rogo; Natalie McCall; Mark Corden; Rex Wong; Madeleine Mukeshimana; Agnes Gatarayiha; Egide Kayonga Ntagungira; Attila Yaman; Juliet Musabeyezu; Anne Sliney; Tej Nuthulaganti; Meredith Kernan; Peter Okwi; Joseph Rhatigan; Jane Barrow; Kim Wilson; Adam C Levine; Rebecca Reece; Michael Koster; Rachel T Moresky; Jennifer E O'Flaherty; Paul E Palumbo; Rashna Ginwalla; Cynthia A Binanay; Nathan Thielman; Michael Relf; Rodney Wright; Mary Hill; Deborah Chyun; Robin T Klar; Linda L McCreary; Tonda L Hughes; Marik Moen; Valli Meeks; Beth Barrows; Marcel E Durieux; Craig D McClain; Amy Bunts; Forrest J Calland; Bethany Hedt-Gauthier; Danny Milner; Giuseppe Raviola; Stacy E Smith; Meenu Tuteja; Urania Magriples; Asghar Rastegar; Linda Arnold; Ira Magaziner; Agnes Binagwaho Journal: Int J Health Policy Manag Date: 2018-11-01
Authors: Egide Abahuje; Isaie Sibomana; Elisee Rwagahirima; Christian Urimubabo; Robert Munyaneza; Jennifer Rickard Journal: Trauma Surg Acute Care Open Date: 2019-08-05
Authors: Richard Newton Iranya; Ronald Mbiine; Andrew Weil Semulimi; Joan Nasige; Timothy Makumbi; Moses Galukande Journal: BMC Surg Date: 2022-07-28 Impact factor: 2.030