Abstract:

Background: Emergency laparotomy is a common emergency general surgical procedure. It is associated with significant pre and post procedural morbidity and mortality. Tanzania, similar to other sub-Saharan African countries, faces significant challenges in the provision of emergency surgical services and reduction of mortality for patients with emergency surgical indications. Identification of predictors of mortality is the first step in improving outcomes for emergency laparotomy, which is deficient in our setting.

Objective: To determine the predictors of thirty-day mortality among adult patients undergoing emergency laparotomy at Bugando Medical Center Mwanza-Tanzania.

Methods: Longitudinal hospital based study was done from February 2019 to June 2019, enrolling patients, aged 18 years and above who under went emergency laparotomy. Before surgery laboratory investigations for serum electrolytes were done but also socio-demographic information, pre-operative risks and time of surgery were documented. Intraoperatively we observed grade of surgeon performing laparotomy and grade of anesthesia provider, postoperative destination was observed too. Patients were reviewed in the ward after laparotomy, followed up after discharge during clinic visits and a review thirty days after emergency laparotomy was done by phone call to determine outcome (alive or dead). Data was analyzed using STATA v13.

Results: A total of 185 patients were enrolled in a study their median age was 37 [IQR 28 – 52] years; most of them were female 55.7% (103/185). There were 27.0% (50/185) peasants; majority had no insurance 63.8% (118/185) and secondary school leavers were 33.0% (61/185). Among the study population 20.0% (37/185) died within thirty days postoperative. Predictors of mortality were age above 60 years (OR 11.8; 95% CI [1.6 – 23.9]; p value 0.004), higher American Society of Anesthesiologist (ASA) class (class II – IV) (OR 3.6; 95% CI [1.8 – 16.2]; p-value = 0.016), pre operative elevated serum sodium level (OR 9.1; 95% CI [4.5 – 39.0]; p-value = 0.005), delay time from booking to cutting (OR 18.43; 95% CI [1.59 – 41.2]; p-value = 0.020), non specialist anesthesia provider (OR 7.6; 95% CI [1.17 – 44.1]; p-value = 0.039) and indirect ICU admission (OR 9.6; 95% CI [2.76 – 28.37]; p-value = 0.044).

Conclusion: In our study the proportion of patients who died within thirty days after emergency laparotomy was high (20.0%). Mortality of patients undergoing emergency laparotomy in our setting can be predicted by age > 60 years, elevated preoperative serum sodium level, higher ASA class (ASA II – IV.), non specialist anesthesia provider and delay in intensive care involvement.

Recommendation: Anesthesia for emergency laparotomy should be provided by anesthesiologists, preoperative electrolytes derangements have to be corrected before surgery and early ICU involvement perioperative.