Waiting time among acute abdominal emergencies in a Nigerian teaching hospital: causes of delay and consequences

Background -In many patients presenting with an acute surgical abdomen, the outcome of management is determined by the promptness of the appropriate surgical intervention. The average interval the patient has to spent waiting for treatment at first presentation to hospital with an acute abdominal emergency is unknown in our center. This study was designed to evaluate the waiting time between hospital presentation and operation,to highlight causes of the delay and outcome of treatment among patients admitted with emergency abdominal events in a Nigerian tertiary health Centre. Method - This is a prospective study of all consecutive patients with the clinical diagnosis of acute surgical abdomen admitted over an 8- month period [March to October 2005] into the surgical services of Usmanu Danfodiyo University Teaching Hospital [UDUTH], Sokoto. Results - One hundred and thirty six patients were studied. There were 95 males and 41 females aged between 3-days and 75 years [median age 25 years]. The waiting time ranged between 4 to 180 hours [> 7 days]; with a mean of 44 hours. Only 13(9.6%) of the patients were operated within 6-hours of hospital admission, considered prompt treatment. Operations after six hours in 123 others was due to several reasons but the commonest reason in [65.4%] was financial constraint. The commonest complication responsible for significant morbidity was wound infection in 31 (22.8%) patients, the majority of whom had delayed surgical operation (n=23/31). Twenty-eight (20.6%) patients died in this study. All but one were from the group operated beyond 6-hours of hospital presentation. Conclusion : The adverse consequences of prolonged waiting time in our center among patients admitted with acute surgical abdomen are most commonly due to financial difficulties. A hospital-based credit scheme available to emergency aptients will rapidly improve the quality of care we give our patients.