The profile and outcomes of patients in a newly established acute surgical care unit in a teaching tertiary hospital in Botswana

Abstract

Background: The scope of emergency general surgical care services varies among health institutions and countries. The burden, profile, and outcomes of patients in many low- to middle-income countries is not adequately investigated.

Methods: Medical records of patients admitted to acute surgical care (ASC) team were reviewed for a year. Demographics, diagnosis, dates of admission and discharges, comorbidities, operative procedures and operative care providers, outcomes, and factors associated with outcomes were analysed.

Result: During the study period, 278 ASC admissions were made. The median age was 32 years. Males constituted 52.5%. The common admissions were acute appendicitis (57.2%), intestinal obstructions (15.5%), and soft-tissue infections (6.1%). Twenty-one point two per cent of the admissions had comorbidities and HIV infection was the commonest comorbidity. Seventy-one point nine per cent of the patients underwent operations. Appendicectomies (72.0%) were the commonest operations. Most of the operations (60.5%) were performed by residents. Complications occurred in 9.7% of the cases of which 6.5% were surgical site infection (SSI) and 2.2% resulted in mortality. Patients with complications had a significantly higher rate of mortality, p < 0.001. For all admissions and operated patients longer onset of illness was associated with longer hospital stays (p = 0.002 and 0.031) and mortality (p = 0.014 and 0.019) respectively. Patients operated by surgeons and residents together had a longer hospital stay than only by residents, p < 0.001. Similarly, when surgeons operated alone the hospital stay was longer than residents, p = 0.002.

Conclusion: The commonest ASC pathology was acute appendicitis. Longer onset of symptoms was associated with longer hospital stay and mortality. This study provides foundational data relevant to surgical education and unit organisation, including the development of clinical guidelines, resident supervision, and workforce planning.