Michelle T D Smith1,2,3, John L Bruce4,5, Damian L Clarke4,5,6. 1. Department of General Surgery & Trauma, Greys Hospital, Pietermaritzburg, South Africa. mtdsmith1708@yahoo.com. 2. Department of Surgery, University of KwaZulu Natal, Durban, South Africa. mtdsmith1708@yahoo.com. 3. Department of General Surgery, Pietermaritzburg Metropolitan Complex, Trauma & Burns, Pietermaritzburg, South Africa. mtdsmith1708@yahoo.com. 4. Department of General Surgery & Trauma, Greys Hospital, Pietermaritzburg, South Africa. 5. Department of Surgery, University of KwaZulu Natal, Durban, South Africa. 6. Department of Surgery, University of Witwatersrand, Johannesburg, South Africa.
Abstract
INTRODUCTION: This project aims to define the common comorbidities associated with patients undergoing emergency laparotomy in South Africa, to review the impact of these comorbidities on outcome and to attempt to model these various factors. METHOD: A retrospective review of all patients undergoing emergency laparotomy for an emergency general surgical condition was performed from the prospectively entered Hybrid Electronic Medical Registry (HEMR). Univariate and multiple logistic regression analysis was performed to establish associations and independent risk factors for developing an adverse event. RESULTS: Over a six-year time period, a total of 1464 patients underwent emergency laparotomy. The median age was 34 years. Males constituted 58.8% (861) of the patients and 754 patients (51.5%) experienced at least one adverse event. The mortality rate was 12 percent. Comorbidities and social factors were documented in 912 patients (62.3%). The rate of adverse events among patients with comorbidities was 59% (538). Patients without comorbidities or significant social factors had an adverse event rate of 39.1% (216). This difference was statistically significant (p < 0.001). The most frequent comorbidity in our sample was HIV, followed by hypertension, underlying malignancy, diabetes mellitus, active TB and cardiovascular disease. CONCLUSION: Emergency laparotomy in South Africa is associated with significant morbidity and mortality. The patients are younger than in high-income countries. Diabetes mellitus, hypertension, HIV and active TB are associated with the development of an AE.
INTRODUCTION: This project aims to define the common comorbidities associated with patients undergoing emergency laparotomy in South Africa, to review the impact of these comorbidities on outcome and to attempt to model these various factors. METHOD: A retrospective review of all patients undergoing emergency laparotomy for an emergency general surgical condition was performed from the prospectively entered Hybrid Electronic Medical Registry (HEMR). Univariate and multiple logistic regression analysis was performed to establish associations and independent risk factors for developing an adverse event. RESULTS: Over a six-year time period, a total of 1464 patients underwent emergency laparotomy. The median age was 34 years. Males constituted 58.8% (861) of the patients and 754 patients (51.5%) experienced at least one adverse event. The mortality rate was 12 percent. Comorbidities and social factors were documented in 912 patients (62.3%). The rate of adverse events among patients with comorbidities was 59% (538). Patients without comorbidities or significant social factors had an adverse event rate of 39.1% (216). This difference was statistically significant (p < 0.001). The most frequent comorbidity in our sample was HIV, followed by hypertension, underlying malignancy, diabetes mellitus, active TB and cardiovascular disease. CONCLUSION: Emergency laparotomy in South Africa is associated with significant morbidity and mortality. The patients are younger than in high-income countries. Diabetes mellitus, hypertension, HIV and active TB are associated with the development of an AE.
Authors: L T Tengberg; M Cihoric; N B Foss; M Bay-Nielsen; I Gögenur; R Henriksen; T K Jensen; M-B Tolstrup; L B J Nielsen Journal: Anaesthesia Date: 2016-11-03 Impact factor: 6.955