Emergency laparotomy at district hospitals in a developing nation: a review of indications and outcomes of treatment

Abstract

Objective: Recently, emergency and essential surgical and anesthesia care at district hospitals is increasingly gaining recognition as a critical, though neglected element of health care system in Africa and other developing nations. Emergency laparotomy is a versatile procedure that can cure a great deal of acute abdominal conditions. The aim of this study was to document the indications and outcomes of laparotomy for emergency abdominal surgical conditions in our district hospitals. Methods: This retrospective study was undertaken in district hospitals from January 2009 to December 2018. Associations between different variables were measured and compared using statistical tests of significance. Results: Of the 879 patients evaluated, appendicitis (n=361, 41.1%) was the most frequent indication for emergency laparotomy followed by complicated external hernias (n=120, 13.7%). Other indications were adhesive intestinal obstruction (n=111, 12.6%), typhoid perforation (n=98, 11.1%), perforated peptic ulcer (n=89, 10.1%), trauma (n=58, 6.6%), colorectal cancer (CRC) (n=18, 2.0%) and others (n=24, 2.8%). The vast majority of patients (n=726, 82.6%) were presented after 24 hours of the onset of disease. Approximately, one-third of patients (n=278, 31.6%) had comorbidities, 867 (98.6%) had high ASA scores (III and IV) and 105 (11.9%) received intestinal resection with or without stoma. The main independent predictors of mortality were late presentation (P=0.003), generalized peritonitis (P=0.001), bowel resection (P=0.000) and high ASA (III and IV) scores (P=0.000). Overall, the mortality rate was 10.6%. The commonest complication was wound infection (39.7%), followed by intra-abdominal collection (10.0%). Conclusion: The most common indication for emergency laparotomy was appendicitis followed by complicated hernias. The major independent predictors of mortality included bowel resection, high ASA score, late presentation and generalized peritonitis.