Abstract:

Background: The triad of referral delays encompassing seeking care, reaching care, and receiving care have been used to assess access to treatment both in medical and surgical care at different levels of care. However the effect of potential referral factors on the surgical treatment outcome of referred Emergency General Surgery patient admitted at BMC have not been determined, also the surgical treatment outcome of referred Emergency General Surgery patient admitted at the tertiary level hospital is insufficiently documented in Tanzania . This study was conducted to determine the factors associated with in-hospital mortality, readmission rate in 30days, and length of hospital stay among referred Emergency General Surgery patients admitted at Bugando Medical Centre a tertiary hospital in Tanzania.

Methods: This was the longitudinal observational study conducted at Bugando Medical Centre involving admitted patients of all age groups referred from other facilities with emergency general surgery diagnoses from June 2021 to February 2022. Permission to conduct the study was obtained from Bugando Medical Centre/Catholic University of Health and Allied Science authorities with clearance certificate number CREC/482/2021.

Results: A total of 280 referred emergency general surgery participants were enrolled into the study. 37.9% had more than 14 days of hospital stay with median of 10days (IQR=7-21), in hospital mortality was observed in 22.1 % and 30 days readmission was 10.7%.Length of hospital stay was significantly associated with direct surgical ward admission, general abdominal conditions and soft tissue conditions, surgical operation conducted more than 48hours of admission, duration of operation more than 2hours and more than one surgical operations at BMC. Mortality were significantly associated with age below 15 years and above 35years, Non insured patients, resuscitation status before admission at BMC, ambulance brought in patients and more than one surgical operation at a referring facility. 30 days readmission was significantly associated with age >35 years, comorbidity and operation status at referring facility.

Conclusion: Referred emergency general surgery patients population is disadvantaged by having prolonged length of hospital stay, significant in hospital mortality and 30days hospital re-admission, surgical care offered at referring facility and receiving facility both predict overall treatment outcome at tertiary level hospitals in Tanzania.