Emergency anaesthesia and surgery at Mulago Hospital: Outcomes and associated factors at 24 hours perioperative. A prospective study
Abstract
Background
Emergency anaesthesia and surgery are associated with an increased risk of morbidity and mortality, particularly in resource-limited settings. Identifying the factors influencing the outcome of patients undergoing emergency surgery will provide recommendations on how to improve the quality of perioperative care in this high-risk patient group.
Objective
To describe the perioperative outcomes and associated factors at 24 hours post-emergency surgery at Mulago National Referral Hospital
Materials and Methods
This was a prospective cohort study conducted among patients who had received emergency surgery in Mulago Hospital emergency theatre for four months. Systematic sampling was used. Data was collected using interviewer-administered questionnaires, and analysed using STATA. The primary outcome was perioperative mortality at 24 hours post recruitment. The secondary outcome was the prevalence of postoperative complications at 24 hours.
Results
Three hundred eighty three (383) patients were recruited into the study. Out of the 383 patients, 18 patients died (4.7%). Following multivariate analysis, ASA physical status IV (p=0.003, OR =140 CI; 5.48-3590) and V (p value= 0.002 OR=990 CI; 13.76-71234), delay to receive emergency surgery of more than 48 hours (p value=0.003 OR =20.4 CI; 2.7-151) and acute kidney injury (p=0.035 OR=5.9 CI;1.1-31.0) were associated with mortality. Patients who required ICU admission for various complications and were unable to get admitted to ICU were more likely to die. (p=0.017 OR= 12.7 CI; 1.6-101). Seventy five patients (20.0%) developed a postoperative complication. Abdominal surgery was associated with an increased risk of developing postoperative complications (p value=0.004 OR= 2.5 1.3-4.7).
Conclusion
Eighteen patients (4.7%) who had undergone emergency surgery at Mulago Hospital died. The most common complications were perioperative hypotension and acute kidney injury. The main contributing factors to mortality were high ASA score of IV and V, delay to receive surgery of more than 48 hours, and unavailability of ICU space when required.