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

IF 1.5 Q3 EMERGENCY MEDICINE Open Access Emergency Medicine Pub Date : 2023-10-19 eCollection Date: 2023-01-01 DOI:10.2147/OAEM.S430193
Tilahun Deresse, Esubalew Tesfahun, Zenebe Abebe Gebreegziabher, Mandante Bogale, Dawit Alemayehu, Megbar Dessalegn, Tewodros Kifleyohans, George Eskandar
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Abstract

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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乙状结肠扭转患者急诊剖腹手术后围手术期不良结局及其预测因素:回顾性随访研究。
背景:急性乙状结肠扭转是一种结肠闭环梗阻的外科紧急情况,通常需要紧急剖腹手术,这与许多术后并发症有关。尽管乙状结肠扭转是埃塞俄比亚肠梗阻的主要原因,但当地对其治疗结果的研究有限。目的:评估2023年埃塞俄比亚阿姆哈拉地区Debre Markos综合专科医院(DMCSH)急诊剖腹治疗乙状结肠扭转的围手术期不良后果的程度和预测因素。方法:这是一项回顾性随访研究。描述性统计用于测量围手术期结果和其他研究变量。使用双变量和多变量逻辑回归模型来确定不良手术结果的预测因素。在p<0.05(95%置信区间)时,相关性被认为是显著的。结果:总共有170名研究参与者入选,有效率为91.4%。49名患者(28.8%)出现围手术期不良结果。肺炎(29例,28.1%)、手术部位感染(19例,18.4%)和伤口裂开(10例,9.7%)是最常见的并发症。术前休克[AOR:3.87(95%CI:(1.22,12.28))]、腹膜脓液或粪便污染[AOR:4.43(95%CI:(1.35,14.47)]和较高的美国麻醉师协会(ASA)评分[AOR:2.37(95%CI:(1.05,5.34)]被确定为围手术期不良事件的预测因素。结论:本研究中的围手术期不良结果高于埃塞俄比亚国家和全球报告中报道的紧急剖腹产术后的不良结果。表现时的低血压、腹膜的脓液和/或粪便污染以及较高的ASA评分是围手术期不良结果增加的有力预测因素。因此,参与提供紧急手术护理的医疗保健提供者和机构应强调早期手术干预、充分复苏和患者监测的重要性,以改善围手术期结果。
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来源期刊
Open Access Emergency Medicine
Open Access Emergency Medicine EMERGENCY MEDICINE-
CiteScore
2.60
自引率
6.70%
发文量
85
审稿时长
16 weeks
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