Predictors and short term outcomes for patients who underwent laparotomy at Muhimbili National Hospital a cross section study.

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.