Cost implication of abdominal wound dehiscence in obstetric patients at UNTH Enugu, 1990 - 1999

Abstract

Aim: To evaluate the magnitude of cost involved in treating abdominal wound dehiscence in obstetric patients at the University of Nigeria Teaching Hospital (U.N.T.H) Enugu and estimate the impact of such costs on parturients. Methods: A retrospective case - note based audit was carried out in obstetric patients who developed abdominal wound dehiscence in UNTH Enugu between January 1990 and December 1999. Direct and indirect costs were estimated and their impact analysed. Results: Fifty-six cases of abdominal wound dehiscence occurred in 2460 caesarean sections and 48 laparotomies resulting in a prevalence of 2.2%. Seven (12.5%) complete abdominal wound dehiscence and 49 (87.5%) partial abdominal wound dehiscence were recorded. The mean age of affected women was 27±4.3 years. Their parity ranged from 0-6. Most of the women (69.6%) were is social classes 4 and 5. Their mean duration of hospitalisation was 26.7±11.8 days. In 57.1%, the surgeries were done as emergency and in 30.4%, they were booked. The estimated total cost of treatment in the affected parturients was 1,172,089 Naira. Except for 2 women in social class 1, the rest needed 2-6 times their monthly income to offset the cost of treatment. Treatment costs were significantly higher in unbooked women than their booked counterparts (p<0.05); 73.1 % of direct costs were incurred in women who did not have either pre-or intra -operative antibiotics. Conclusion: Prolonged hospitalisation, high cost of treatment, and prolonged job loss, which might lead to aversion to obstetric operations and hospital delivery, were evident. The consequence is a self- perpetuating cycle of high costs and increased morbidity. It is expected that with the mass mobilization of our parturients to good antenatal care and safe delivery, the cost of obstetric services in our centre will reduce.

Keywords

• cost implication
• wound dehiscence
• obstetrics