Surgery in Practice and Science (Sep 2023)
Preoperative waiting time and outcomes of non-traumatic emergency abdominal surgeries: Insights from a zonal referral hospital in northern Tanzania, a reference for health centers with similar capacities
Abstract
Background: Non-traumatic emergency abdominal surgeries are common in most healthcare settings. To a significant extent, the outcomes of treatment are determined by the promptness of surgical interventions. However, the in-hospital waiting time which reflects perioperative promptness remains largely unexplored in developing countries. Objective: To describe the preoperative waiting time, identify the causes of delays, and determine subsequent outcomes for non-traumatic emergency abdominal surgeries. Methods: A cross-sectional study was conducted at a consultant zonal hospital in northern Tanzania from September 2012 to March 2013. Patients admitted and surgically treated for non-traumatic acute abdominal conditions were consecutively sampled. Sociodemographic and clinical data were obtained from medical records. Delays in surgical interventions were assessed based on observations at the Emergency Department and record analysis. Descriptive statistics and regression analysis were used to summarize the data and assess for factors influencing post-operative outcomes, respectively. Results: The study included 111 participants with a median age of 29 years (IQR=18-53). The median in-hospital preoperative waiting was 10.5 hours (IQR=6.6-14.7), with a substantial majority (78.4%) experiencing delays beyond 6 hours. The frequent reasons for delayed surgery included personnel shortage (37.8%), unavailable theater space (31.5%), and investigation-related factors (28.8%). Delayed hospital presentation (symptoms ≥24 hours) (OR=3.9, 95% CI=1.0-14.9) and prolonged waiting time (>6 hours) (OR=2.7, 95% CI=1.0-7.2) were significantly associated (P < 0.05) with in-hospital complications that included wound dehiscence (0.9%), re-operation (3.6%), surgical site infection (18.0%), and complications necessitating Intensive Care Unit admission (36.9%). The in-hospital operative mortality rate was 18.0%. Age of ≤40 years (OR=0.1, 95% CI=0.04-0.4) and ASA-PS class I-II (OR=0.1, 95% CI=0.0-0.3) were identified as significant (P < 0.001) protective factors against operative mortality. Conclusion: These benchmark findings highlight the multifactorial nature of the reasons for delayed surgical interventions and its association with postoperative complications; offering a potential avenue to enhance surgical efficiency in the index and comparable settings.
