Abstract:
Background:Globally, 10% of Disability Adjusted Life years (DALY) are
attributable to surgical amenable conditions. In Tanzania, 19.3% of deaths and 17%
of Disability Adjusted Life year (DALY) are attributed to the diseases amenable to
surgery. The most common surgical procedure is that involving laparotomy as it can
save life if done immediately, hence the most commonly done in lower health
facilities in LMICs Tanzania included. This study therefore, aimed to determine the
predictors and short-term outcomes for patients underwent who Laparotomy at
Muhimbili National Hospital.
Methods: A cross-sectional hospital based study was carried out in the department of
surgery of Muhimbili National Hospital for one year from March2018– March2019.
All patients with indication of primary laparotomy were identified for inclusion into
the study. Data were collected regarding patient's demography, clinical pattern of
laparotomy, indication of laparotomy, procedure done during laparotomy, morbidity
and mortality 30 days postoperative. Data were entered into SPSS version 23 for
analysis where prevalence and p value. Ethical approval for the audit was obtained
from the Muhimbili University of Health IRB.
Results: A total of 400 patients had undergone primary laparotomy, the mean age
was 47 years where 65.8% were male. 223(55.7%) had emergency laparotomy and
145(36.3%) peritonitis was the leading indication. The laparotomy done during
working days was 364(91%) and 340(85%) was done during daytime. The mean
duration of laparotomy procedure was 140 minutes, 172 (43%) required ICU care
after surgery, mean duration of ICU stay was 6 days and mean hospital stay was 10
days. The leading primary procedure had involved bowel resection and anastomosis
127(42.3%).within 30 days post-operative;re-laparotomy was done in 33(8.3%)
patients, intra-abdominal collection of abscessesand surgical site infection were
common complication had (7%).. Cleven-dindo classification scale showed that
71.8% of patient had deviation from normal post-operative course without need for
intervention, 7% required surgical, radiological or endoscopic intervention and 17% died within 30 days postoperative. ASA (P value 0.001) and indication of laparotomy
(P value 0.016) had significant association with having postoperative complication.
Conclusion: The postoperative morbidity and mortality after laparotomy were high.
Protocols for identifying and managing all emergency patients who might need an
emergency laparotomy would perhaps streamline care for this group of high-risk
patients and may improve decision making and overall outcomes.
