背景:与开腹手术相关的死亡率是患者和医疗保健提供者的重要关注点。在非洲,由于劳动力资源稀缺和用于检测出现并发症的患者的生理恶化的预警系统不足,这尤其令人担忧。
方法:这项前瞻性队列研究旨在随访在乌干达Lacor医院接受急诊或择期腹部手术的患者。参与者是4月27日在医院接受腹部手术的患者,2019年7月07日,2021年。训练有素的研究人员使用标准化表格收集数据,其中包括人口统计信息(年龄,性别,电话联系,和位置),手术适应症,外科手术,术前健康状况,术后发病率和死亡率,和住院时间。
结果:本研究涉及124例患者,大部分是男性,平均年龄35岁,表现为腹痛和不同的潜在合并症。择期病例占总数的60.2%。急诊和择期手术的常见原因分别为胃十二指肠穿孔和胆石症。并发症发生率为17.7%,手术部位感染最常见。死亡率为7.3%,和几个因素如术前低血压,肾功能紊乱,术后使用血管加压药,术后辅助通气与之相关。择期和急诊手术患者的生存率(P值=0.41)或住院时间(P值=0.17)没有显着差异。然而,发病率有显著差异(p<0.001)。
结论:胆石症和胃十二指肠穿孔是关键的手术指征,术后通气和肾上腺素输注等因素与死亡率有关。急诊手术并发症发生率较高,特别是手术部位感染,尽管与择期手术相比,住院时间和死亡率相似。
BACKGROUND: The mortality rate associated with open abdominal surgery is a significant concern for patients and healthcare providers. This is particularly worrisome in Africa due to scarce workforce resources and poor early warning systems for detecting physiological deterioration in patients who develop complications.
METHODS: This prospective cohort
study aimed to follow patients who underwent emergency or elective abdominal surgery at Lacor Hospital in Uganda. The participants were patients who underwent abdominal surgery at the hospital between April 27th, 2019 and July 07th, 2021. Trained research staff collected data using standardized forms, which included demographic information (age, gender, telephone contact, and location), surgical indications, surgical procedures, preoperative health status, postoperative morbidity and mortality, and length of hospital stay.
RESULTS: The present
study involved 124 patients, mostly male, with an average age of 35 years, who presented with abdominal pain and varying underlying comorbidities. Elective cases constituted 60.2% of the total. The common reasons for emergency and elective surgery were gastroduodenal perforation and cholelithiasis respectively. The complication rate was 17.7%, with surgical site infections being the most frequent. The mortality rate was 7.3%, and several factors such as preoperative hypotension, deranged renal function, postoperative use of vasopressors, and postoperative assisted ventilation were associated with it. Elective and emergency-operated patients showed no significant difference in survival (P-value = 0.41) or length of hospital stay (P-value = 0.17). However, there was a significant difference in morbidity (p < 0.001).
CONCLUSIONS: Cholelithiasis and gastroduodenal perforation were key surgical indications, with factors like postoperative ventilation and adrenaline infusion linked to mortality. Emergency surgeries had higher complication rates, particularly surgical site infections, despite similar hospital stay and mortality rates compared to elective surgeries.