Abstract:

Background: Abdominal re-operation is any repeated operation for an intra-abdominal procedure or wound complication on index admission or on a subsequent admission to hospital within a post-operative period of sixty (60) days. It is usually performed in case of post-operative complications either as a re-laparotomy, stomal complications or wound complications depending on the initial type of surgery. Incidence of abdominal re-operation differs according to the hospital’s settings, patient’s baseline clinical condition and type of primary abdominal surgery. Despite the increased number of surgical re-admissions, and post-operative complications, there is still paucity of data describing burden, indications, outcomes and prognostic factors of abdominal re-operations at Bugando medical centre.

Objective: This study was conducted to determine indications, outcomes and prognostic factors for abdominal re-operations at Bugando medical centre.

Methods: Analytical cross sectional study conducted at Bugando medical centre from August 2017 to July 2018 using convenient sampling technique to recruit patients admitted for abdominal re-operations during this period and who met inclusion criteria. Swahili translated structured questionnaire was used to collect socio-demographic and clinical information. Data were entered into a Microsoft excel sheet and statistical analysis was done using Stata version 14.2.

Results: A total of 104 patients were enrolled, of whom 41(39.4%) were males and 63(60.6%) were females, giving a male to female ratio of 1: 1.5. Their ages at diagnosis were ranging from 1 day to 76 years with median age of 29 [IQR 17 – 46] years. Proportion of patients who died following abdominal re-operation was 28.9% (30). The most common indications for abdominal re-operation were peritonitis 45 (43.3%), burst abdomen 29 (28.0%) and anastomotic leak 18 (17.3%). Stoma complications 7 (6.7%), hemorrhage 4 (3.9%) and post operative paralytic ileus 1 (1.0%) were also recorded but at a lesser frequency. Independent predictors of mortality from abdominal re-operations were older age and increasing number of abdominal re-operations.

Conclusion: Abdominal re-operation is associated with high mortality. The most common indications for abdominal re-operation were peritonitis, burst abdomen and anastomotic leak. Predictors of mortality were older age and increasing number of abdominal re-operations. . Hence it is recommended that patients with peritonitis, burst abdomen or anastomotic leak be managed in a timely and well planned manner to minimize the number of unnecessary reoperations which may increase the risk for mortality.