Patient's characteristics, management practices and outcome of re-laparotomies in a tertiary hospital in Tanzania

Postoperative Complications and Factors Associated with Surgical Site Infection at Muhimbili National Hospital, Dar es Salaam, Tanzania: A cross-Sectional study

Background

Postoperative complications are a leading cause of morbidity and mortality to surgical patients. Different complications are encountered in clinical practice, however surgical site infection (SSI) appears to be the most common. To date, limited published information is known pertaining to the patterns of postoperative complications and factors associated with SSI among patients operated on in other hospitals in Tanzania and referred to Muhimbili national hospital for further management. Therefore, the purpose of this study was to identify patterns of postoperative complications and factors associated with SSI among the study participants.

Methods

This was a hospital based cross-sectional study conducted at Muhimbili national hospital from August 2022 to January 2023, which included 181 patients. Obtained data was analysed using frequency tables, Pearson Chi-squared test and binary logistic regression model, at a level of significance of <0.05.

Results

One hundred eighty one (181) patients were included in this study, of whom 113(62.4%) were females; median age was 39 years. Cigarette smokers and alcohol consumers were 42(23.2%) and 90(49.7%) respectively. Diabetic patients were 8(4.4%), 35(19.3%) were HIV positive and 52(28.7%) had hypertension. Patients whose diagnosis was related to general surgery accounted for 50.2%, whereas 30.9% were obstetric cases. Patients who had undergone Caesarean section were 45(24.9%), whereas 20(11%) patients had undergone total abdominal hysterectomy. Bowel resection and primary anastomosis included 16(8.8%) patients and perforated peptic ulcer repair 8(4.4%) patients. Patients with infected peritoneal collection were 34(18.8%), postpartum haemorrhage 18(9.9%) and bowel perforation 10(5.5%). Patients who had undergone relaparotomy as part of treatment were 70(38.7%), whereas 30(16.6%) patients with SSIs were treated by serial wound dressing and 26(14.4%) patients were admitted and nursed in intensive care unit. None of the factors was found to have a statistically significant association with SSI.

Conclusions

There is a large proportion of patients suffering from postoperative complications after gastroenterology and obstetric surgeries; and of all complications encountered in this study; SSI was the most common contributing 52%, followed by gastrointestinal complications at 31%. Despite the fact that multiple factors were associated with SSI, none of them was found to be statistically significant.

Magnitude of early relaparotomy and its outcome among patients who underwent laparotomy in a tertiary hospital in Eastern Ethiopia: a cross- sectional study

INTRODUCTION

Several studies conducted worldwide revealed the magnitude of early relaparotomy and its outcome among patients undergoing laparotomy. However, there was very little evidence on the magnitude of early relaparotomy and its outcome among patients who underwent laparotomy in Ethiopia, especially in the study area.

OBJECTIVE

this study aimed to the assess magnitude of early relaparotomy and its outcome among patients who underwent laparotomy in a Tertiary Hospital in Eastern Ethiopia.

METHODS

A retrospective cross-sectional study was conducted. All patients who underwent laparotomy during the data retrieval period were included. Data were collected using a data abstraction checklist from patients' medical records. The collected data were entered, cleaned, and analyzed by using SPSS version 23. Descriptives statistics were generated where by continuous variables were summarized into means and standard deviation and categorical variables were summarized as the frequency with proportions.

RESULT

The magnitude of relaparotomy was 6.8%. Among 82 patients included in the final analysis, 53 (64.6%) were males and the mean (± SD) age of patients was 33.32 ± 16.63 years. The major indications for relaparotomy were intra-abdominal collection (26.8%) and anastomotic leak (24.4%). Among 82 patients who underwent relaparotomy, 52(63.4%) were developed post relaparotomy complications, and 30(36.6%) patients died.

CONCLUSION

The magnitude of early relaparotomy was 6.8%. The magnitude of in-hospital mortality was high in comparison to earlier study findings from developing countries. About three fourth of patients who underwent relaparotomy were developed postoperative complications.

Factors Associated with Short-Term Surgical Outcomes Among Women Presenting with Pelvic Peritonitis at Bugando Medical Centre Mwanza, Tanzania

Background

Pelvic peritonitis is a rarely reported pathological condition in literature and emergency laparotomies are a common surgical procedure performed for these conditions in developing countries. This study was designed to investigate factors that are associated with short-term surgical outcomes among women with pelvic peritonitis.

Methods

The study included retrospective and prospective data obtained between November 2021 and May 2022 from Bugando Medical Centre (BMC). Standardized data collection tool was used to capture clinical, surgical and laboratory data. Descriptive data analysis was done using STATA version 13.

Results

A total of 101 participants were recruited; 22 prospectively and 79 retrospectively. The median age was 29[Interquartile range (IQR) 24 to 35] years. Majority (76.2%) of participants were referred patients. Obstetric related peritonitis 82.2% (83/101) was the most frequently detected with a necrotic and or dehiscent lower uterine segment (LUS) that necessitated a subtotal abdominal hysterectomy (STAH) being the commonest (40.8%) intraoperative finding. Postoperative complications were reported in 36.7% (36/98) and were significantly associated with pulse rates >100b/min (P=.041) and platelets <150 × 103 mm3 (P=.049). The median length of hospital stay was 19[IQR: 7 to 35] days and temperature >37.5°C (aOR=5.08, 95% CI 1.23-20.97, P=.025) independently predicted prolonged hospital stay. Death occurred in 9.2% of patients and having ASA score of 5 (P=.045) was associated with death. Multi-drug resistant (MDR) gram-negative bacteria (85.2%) were the predominant pathogens causing pelvic peritonitis.

Conclusion

A significant proportion of patients with pelvic peritonitis and deranged sepsis markers develop short-term surgical complications with a significant number of those with fever stay more than 14 days. There is a need of timely complete sepsis work up of the patients with pelvic peritonitis to ensure appropriate management is instituted to prevent associated morbidity and mortality.