Prevalence, incidence and outcomes of intra-abdominal hypertension in patients undergoing emergency laparotomy in Mulago Hospital

Abstract

Background: Intra-abdominal hypertension (IAH) is defined as a sustained elevation in intra-abdominal pressure (IAP) greater than or equal to 12mmHg. IAH has been shown to cause organ derangements and dysfunction in the body. Objective screening of IAH is not done early enough or at all thus leading to significant morbidity and mortality among surgical patients. The epidemiology and outcome of IAH among surgical patients has not been documented in Uganda. The aim of this study was to determine the prevalence, incidence and outcome of intra-abdominal hypertension among patients undergoing emergency laparotomy. Methodology: Prospective observational study, conducted from January to April 2015 among patients undergoing emergency laparotomy. Inclusion criteria was; age >7yrs, scheduled for emergency laparotomy, able to lie supine. Exclusion Criteria: pregnant, failed urethral catheterization, known cardiac, renal and respiratory disorders. Consecutive sampling was used. IAP, blood pressure, heart rate, respiratory rate, Sp02, Serum creatinine, Serum urea, and Urine output were measured preoperatively and postoperatively at 0, 6, 24 and 48 hours. IAH was defined as IAP > 12mmHg on three consecutive readings 5 minutes apart. Results: In total 192 patients were enrolled. Mean age ± SD was 32.78 ± 14.43 yrs with male preponderance (79.17%). The prevalence of IAH was 19.1% and the cumulative incidence after surgery was 22.3%. The statistically significant outcomes associated with IAH were respiratory system dysfunction p-value 0.024, 95% CI (1.129 - 5.610) preoperatively and mortality p-value 0.007, 95% CI (1.371-7.290) preoperatively and p-value 0.034, 95% CI (1.072-8.583) at 6hrs, p-value 0.024, 95% CI (1.203-13.515) at 24hrs postoperatively. Conclusion: The prevalence and incidence of IAH in our study population were high. IAH was associated with mortality and respiratory system dysfunction. This calls for objective monitoring of intraabdominal pressure in patients undergoing emergency laparotomy with the aim of reducing associated mortality.