Outcomes of emergency abdominal surgery in an upper-middle income country urban health care system

Abstract

Background: Abdominal emergencies are common and often require emergency surgery with mortality between 14% and 20%. Strategies have been introduced to reduce complications after emergency abdominal surgery, but resources in low- and middle-income countries (LMICs) countries are limited. There is a paucity of data on emergency abdominal surgery from the developing world. We aim to audit the mortality and morbidity of emergency laparotomies in the unique South African public health care system. Secondary endpoints were to identify system shortfalls to allocate quality improvement programmes to improve outcomes of acute abdominal emergencies.

Methods: A retrospective review of a prospectively maintained database was conducted on emergency surgical procedures at all the public-funded health facilities in the Cape Town Metro West, South Africa.

Results: There were 1471 patients who required emergency abdominal operations. The mean age was 36.7 (standard deviation (SD) = 15.95) with a male preponderance of 64.7%. The median duration of symptoms was 2 days (interquartile range (IQR) = 0–84). Overall 30-day mortality was 8% (n = 118) where 0.95% (n = 14) demised within 24 hours postsurgery. Factors associated with mortality were higher ASA class, higher Eastern Cooperative Oncology Group (ECOG) score, increasing age, higher Codman score, length of the procedure, presence of consultant during procedure, faecal contamination, contamination of more than one abdominal quadrant and use of inotropes intraoperatively.

Conclusion: Despite resource constraints, patients presenting with abdominal emergencies requiring emergency abdominal surgery received care with mortality outcomes comparable to reported literature. This audit can be used as guide to identify healthcare system shortfalls to improve outcomes.