Prevalence and outcomes of gastrectomy at Mulago National Referral Hospital; A cross-sectional study

Abstract

Background: Gastrectomy is a surgical procedure performed for various conditions of the stomach and duodenum. Despite its widespread use, there needs to be more data reporting in-hospital outcomes associated with gastrectomy in our healthcare setting. This study investigated gastrectomy's prevalence and in-hospital outcomes and factors related to these outcomes at Mulago National Referral Hospital (MNRH) from January 2012 to April 2023. Methodology: This retrospective cross-sectional study reviewed medical records of patients who underwent surgery for diseases of the stomach and duodenum at MNRH between January 2012 and April 2023. A total of 274 were found to have undergone surgery for diseases of the stomach and duodenum of which 78 were gastrectomy. Therefore, seventy-eight files were evaluated for morbidity and mortality post-gastrectomy. Data was collected and then analyzed using STATA version 17. Pearson’s chi-square, bivariate, and multivariate logistic regression were used for gastrectomy outcomes to explore associations between independent variables and gastrectomy outcomes. Results: Gastrectomy accounted for 29.9% of all surgeries done for diseases of the stomach a duodenum during the study period. The commonest indication for gastrectomy malignant disease (74.4%). The mortality rate post gastrectomy was 10.3%, while the morbidity rate was 32.8%. The most common complications were surgical site infections (23.1%), gastrointestinal obstruction (15.4%), and anastomotic leaks (6.4%). Prolonged surgery time (>4 hours), the presence of malignancy, and developing post-operative gastrointestinal obstruction were found to be independently associated with postoperative morbidity and mortality. Conclusion: The number of gastrectomies for diseases of the stomach and duodenum is much lower in Uganda than in the rest of the world. Mortality and morbidity post gastrectomy remain higher in Uganda and other LMICs than in high-income countries. We recommend a more extensive and prospective study to address the challenges created by the study's retrospective nature. Early diagnosis of the diseases of the stomach and duodenum while they are still amenable to curative surgery like Gastrectomy. Measures should be put in place to prevent and or quickly identify post-gastrectomy complications to reduce morbidity and mortality rates.