B S Hendriksen1, D Morrell1, L Keeney1, X Candela2, J Oh1, C S Hollenbeak1,3,4, T E Arkorful5, C Newton5, F Amponsah-Manu1,5. 1. Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA. 2. Penn State College of Medicine, Hershey, PA, USA. 3. Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA. 4. Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA. 5. Department of Surgery, Eastern Regional Hospital, Koforidua, Ghana.
Abstract
BACKGROUND: Increased inpatient length of stay (LOS) and readmission represent significant economic burden on patients and families faced with surgical disease in low-middle income countries given limited surgical access, infrastructure, and variable insurance status. STUDY AIM: Identify risk factors for readmission and inpatient LOS in postoperative care in the Eastern Regional Hospital, Ghana. STUDY DESIGN: Retrospective case series. SETTING: Eastern Regional Hospital, Koforidua, Ghana. METHODS: Data for exploratory laparotomy procedures were obtained from surgical case logs collected at the regional referral hospital in Koforidua, Eastern Region, Ghana from July 2017 to June 2018. This information was combined with the hospital electronic medical records to collect demographic data, laboratory values, and outcomes. Multivariable analyses were used to model LOS and readmission. RESULTS: The study included 346 exploratory laparotomy procedures (286 adult, 60 pediatric) for various surgical diseases. The overall 30-day readmission rate was 9.2%. Average LOS was 12.0±20.4 days for readmitted patients and 6.7±5.5 days for patients without readmission. Readmitted patients were more likely to have had preoperative anemia (p=0.009), surgical site infection (P=0.001), or a re-laparotomy (p=0.005). Preoperative anemia (OR=3.5 [95% CI 1.54-7.96], p=0.003) and surgical site infection (OR=3.68 [95% CI 1.36-10.00], p=0.011) were associated with increased odds of readmission. Preoperative anemia was also associated with about 3.0 additional inpatient days (p=0.001). CONCLUSION: Preoperative anemia and surgical site infections represent risk factors for readmission in rural Ghana. Anemia is also associated with longer LOS. Future interventions aimed at treating anemia and preventing surgical site infections may reduce some of the post-operative burden placed on patients and their families.
BACKGROUND: Increased inpatient length of stay (LOS) and readmission represent significant economic burden on patients and families faced with surgical disease in low-middle income countries given limited surgical access, infrastructure, and variable insurance status. STUDY AIM: Identify risk factors for readmission and inpatient LOS in postoperative care in the Eastern Regional Hospital, Ghana. STUDY DESIGN: Retrospective case series. SETTING: Eastern Regional Hospital, Koforidua, Ghana. METHODS: Data for exploratory laparotomy procedures were obtained from surgical case logs collected at the regional referral hospital in Koforidua, Eastern Region, Ghana from July 2017 to June 2018. This information was combined with the hospital electronic medical records to collect demographic data, laboratory values, and outcomes. Multivariable analyses were used to model LOS and readmission. RESULTS: The study included 346 exploratory laparotomy procedures (286 adult, 60 pediatric) for various surgical diseases. The overall 30-day readmission rate was 9.2%. Average LOS was 12.0±20.4 days for readmitted patients and 6.7±5.5 days for patients without readmission. Readmitted patients were more likely to have had preoperative anemia (p=0.009), surgical site infection (P=0.001), or a re-laparotomy (p=0.005). Preoperative anemia (OR=3.5 [95% CI 1.54-7.96], p=0.003) and surgical site infection (OR=3.68 [95% CI 1.36-10.00], p=0.011) were associated with increased odds of readmission. Preoperative anemia was also associated with about 3.0 additional inpatient days (p=0.001). CONCLUSION: Preoperative anemia and surgical site infections represent risk factors for readmission in rural Ghana. Anemia is also associated with longer LOS. Future interventions aimed at treating anemia and preventing surgical site infections may reduce some of the post-operative burden placed on patients and their families.
Authors: Shelly Choo; Henry Perry; Afua A J Hesse; Francis Abantanga; Elias Sory; Hayley Osen; Charles Fleischer-Djoleto; Rachel Moresky; Colin W McCord; Meena Cherian; Fizan Abdullah Journal: Trop Med Int Health Date: 2010-07-14 Impact factor: 2.622
Authors: Ahmed Zakariah; Barclay T Stewart; Edmund Boateng; Christiana Achena; Gavin Tansley; Charles Mock Journal: Prehosp Disaster Med Date: 2016-12-12 Impact factor: 2.040
Authors: John G Meara; Andrew J M Leather; Lars Hagander; Blake C Alkire; Nivaldo Alonso; Emmanuel A Ameh; Stephen W Bickler; Lesong Conteh; Anna J Dare; Justine Davies; Eunice Dérivois Mérisier; Shenaaz El-Halabi; Paul E Farmer; Atul Gawande; Rowan Gillies; Sarah L M Greenberg; Caris E Grimes; Russell L Gruen; Edna Adan Ismail; Thaim Buya Kamara; Chris Lavy; Ganbold Lundeg; Nyengo C Mkandawire; Nakul P Raykar; Johanna N Riesel; Edgar Rodas; John Rose; Nobhojit Roy; Mark G Shrime; Richard Sullivan; Stéphane Verguet; David Watters; Thomas G Weiser; Iain H Wilson; Gavin Yamey; Winnie Yip Journal: Lancet Date: 2015-04-26 Impact factor: 79.321
Authors: Mercy A Nuamah; Joyce L Browne; Alexander V Öry; Nelson Damale; Kerstin Klipstein-Grobusch; Marcus J Rijken Journal: Reprod Health Date: 2017-11-02 Impact factor: 3.223