School of Medicine (Sch. of Med.)

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Browsing School of Medicine (Sch. of Med.) by Subject "Abdominal surgery"
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    Association of surgical procedure start time and post operative outcomes following emergency abdominal surgery at Mulago National Referral Hospital - A five year retrospective cohort study
    (Makerere University, 2022) Asiimwe, Joshua
    Background: Emergency abdominal surgeries are among the high-risk procedures with unacceptably high morbidity and mortality rates in the whole world, despite advances in surgical techniques and intensive care services. Studies have shown mixed results for morbidity and mortality outcomes in surgical procedures performed in out of hours (nightshift) but this association is yet to be evaluated in Uganda. Objective: We aimed to evaluate the association between time of day and outcome of Emergency abdominal surgical procedures done at Mulago national referral hospital over a five-year period. Method: We conducted a retrospective cohort analysis of file records of patients, aged 13 years and above who had emergency abdominal surgery performed at Mulago National referral hospital from 1st January 2016 to 31st of December 2020. The data extracted from the files included: Surgery start time, patient demographics, and comorbidities, details of the emergency abdominal procedure undertaken, intraoperative adverse events and outcomes (in-hospital mortality and morbidity). We used logistic regression to assess association between emergency abdominal surgery start time and outcomes. All analysis were conducted using STATA version 16, with a significance level set at p<0.05 Results: A total of 1370 patient charts for emergency abdominal surgeries were analyzed. Cases operated during the day were 1116 (81.5%) compared to the 254 cases (18.5%) operated during the night hours. The male cases were 974 (71.2%) and the females, 394 (28.8%). In-hospital postoperative complications occurred in 205 cases (15.0%) and the in-hospital mortality rate for this cohort was 11.9% (n=163 cases). Emergency abdominal surgeries done during the night had 7.14 times higher odds of dying in the hospital compared to those done during daytime (adjusted OR= 7.14, p<0.0001). Nighttime surgery was significantly associated with higher complication rates compared to day-time emergency abdominal surgery (Adjusted OR = 1.69 P=0.01) Surgical site infection was the commonest post-operative complication 14.6% (n=201) Conclusion: Night time emergency abdominal surgeries at Mulago national referral hospital, Uganda have higher odds of in hospital morbidity and mortality.
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    Surgical site Infections and antimicrobial susceptibility patterns among patients undergoing abdominal surgery at Mulago National Referral Hospital: A prospective cohort study
    (Makerere University, 2024) Kule, Lawrence
    Background: Surgical site infections (SSIs) remain a major cause of morbidity and mortality among post-operative patients. The care for these patients is further compromised by the ever-increasing antimicrobial resistance. This calls for periodic assessment of antimicrobial susceptibility patterns tailored to individual hospitals. Objective: To determine the incidence of surgical site infections, associated factors, causative microorganisms and susceptibility patterns to antimicrobial agents, among patients undergoing abdominal surgery in Mulago National Referral Hospital (MNRH). Method This was a prospective study of consecutively sampled patients aged 13 years and older, who had abdominal surgery done at MNRH between May 2023 and November 2023. Sociodemographic data, clinical characteristics and management parameters were assessed for each participant. The participants were then followed up until development of features of SSI and up to a maximum of 30 days postoperatively to assess for presence of surgical site infection. Those with features of surgical site infection had wound swabs collected for microbial culture and sensitivity testing. Incidence of SSI, etiology and antimicrobial sensitivity patterns were measured as percentage proportions. Logistic regression model was used to assess associated factors for development of SSI.Results: 276 participants who underwent abdominal surgery were evaluated. The median age was 38 years (IQR: 27-52 years); male participants were 160 (58%) and females, 116 (42%). Cumulative incidence of SSI was 12% (33 cases). Escherichia coli, 16 (48.5%) and Klebsiella pneumoniae, 8 (24.2%) were the commonest isolated organisms from SSI wound swabs. Approximately 91% of the bacteria isolated were multi drug resistant (MDR), with 78% of the enterobactericeae isolated being extended spectrum beta-lactamase (ESBL) producers and 14.8% of them had resistance to Carbapenem antibiotics (CRE). Multivariate logistic regression model revealed contaminated (adjusted RR= 4.1; 95% CI: 1.1 – 15.3, p=0.035) and dirty wound (adjusted RR=16.9, 95% CI: 2.7 – 104.6, p=0.002) classifications to be significantly associated with development of SSI. Conclusion Surgical site infection rate following abdominal surgery at MNRH is lower than rates reported within the region. Contaminated and dirty surgical wounds are major risk factors for abdominal SSI. Enterobacteriaceae are the commonest causative organisms, with high proportion of multi-drug resistant strains.