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Edyedu I, Okedi FX, Muhumuza J, Asiimwe D, Laker G, Lule H. Factors associated with peptic ulcer perforations in Uganda: a multi-hospital cross-sectional study. BMC Gastroenterol 2024; 24:199. [PMID: 38886654 PMCID: PMC11181620 DOI: 10.1186/s12876-024-03285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Perforated peptic ulcer is the worst complication of peptic ulcer disease whose burden is disproportionately higher in low-income settings. However, there is paucity of published data on the patterns of perforated peptic ulcer in the region. The aim of this study was to determine the factors associated with anatomical patterns of peptic ulcer perforation, as well as the clinical, socio-demographic, and anatomical patterns among patients in Uganda. METHODS This was a cross sectional study that enrolled 81 consecutive patients with perforated peptic ulcers. Using a structured pretested questionnaire the social demographic and clinical characteristics were obtained. At surgery, the patterns of the perforations were determined. Logistic regression was done in SPSS version 22 to determine the factors associated with the anatomical patterns. RESULTS Perforated peptic ulcer disease was more prevalent among males (79.5%), peasants (56.8%) and those from rural areas (65.4%). Majority of study participants were of blood group O (43.2%). Gastric perforations were more common (74.1%). Majority of the perforations were found anteriorly (81.5%). Being a casual laborer was independently associated with lower odds of having a gastric perforation compared to being a peasant farmer (P < 0.05). CONCLUSION Public health campaigns aimed at prevention of peptic ulcer perforations should prioritize the males, peasants and those living in rural areas. When a patient in our setting is suspected to have a peptic ulcer perforation, the anterior part of the stomach should be considered as the most likely site involved more so in peasant farmers.
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Affiliation(s)
- Isaac Edyedu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Francis Xaviour Okedi
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Joshua Muhumuza
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Daniel Asiimwe
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Goretty Laker
- Faculty of Clinical Medicine and Dentistry, Department of pediatrics and child health, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Herman Lule
- Injury Epidemiology and Prevention Research Group, Division of Clinical Neuroscience, University of Turku, Turku, Finland
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Ogbuanya AUO, Eni UE, Umezurike DA, Obasi AA, Ikpeze S. Associated Factors of Leaked Repair Following Omentopexy for Perforated Peptic Ulcer Disease; a Cross-sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2023; 12:e18. [PMID: 38371449 PMCID: PMC10871054 DOI: 10.22037/aaem.v12i1.2169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Introduction Previous studies have reported numerous clinico-pathologic risk factors associated with increased risk of leaked repair following omental patch for perforated peptic ulcer disease (PPUD). This study aimed to analyze the risk factors associated with leaked repair of omental patch and document the management and outcome of established cases of leaked repair in a resource-poor setting. Methods This is a multicenter cross-sectional study of leaked repair after omental patch of PPUD between January 2016 to December 2022. Following primary repair of PPUD with omental pedicle reinforcement, associated factors of leaked repair were evaluated using univariate and multivariate analyses. Results Overall, 360 cases were evaluated (62.8% male). Leaked repair rate was 11.7% (42 cases). Those without immunosuppression were 3 times less likely to have leaked repair (aOR= 0.34; 95% CI: 0.16 - 0.72; p = 0.003) while those with sepsis were 4 times more likely to have leaked repair (aOR=4.16; 95% CI: 1.06 - 12.36; p = 0.018). Patients with delayed presentation (>48 hours) were 2.5 times more likely to have leaked repair than those who presented in 0 - 24 hours (aOR=2.51; 95% CI: 3.62 - 10.57; p = 0.044). Those with Perforation diameter 2.1-3.0 cm were 8 times (aOR=7.98; 95% CI: 2.63-24.21; p<0.0001), and those with perforation diameter > 3.0cm were 33 times (aOR=33.04; 95% CI: 10.98-100.25; p<0.0001) more likely to have leaked repair than those with perforation diameter of 0-1.0 cm. Similarly, in those with no perioperative shock, leaked repair was 4 times less likely to develop than those with perioperative shock (aOR= 0.42; 95% CI: 0.41-0.92; p = 0.041). There was significant statistical difference in morbidity (p = 0.003) and mortality (p < 0.0001) rates for cases of leaked repairs and successful repairs. Conclusion Leaked repair following omentopexy for peptic ulcer perforation was significantly associated with large perforation diameter, delayed presentation, sepsis, immunosuppressive therapy, and perioperative shock.
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Affiliation(s)
- Aloysius Ugwu-Olisa Ogbuanya
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Southeast Nigeria
- Department of surgery, Bishop Shanahan Specialist Hospital, Nsukka, Enugu state, Southeast Nigeria
- Department of Surgery, Mater Misericordie Hospital, Afikpo, Ebonyi State, Southeast Nigeria
- Department of Surgery, District Hospital, Nsukka, Enugu State, Southeast Nigeria
- Department of surgery, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo (AEFUNAI), Ebonyi State, Southeast Nigeria
| | - Uche Emmanuel Eni
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Southeast Nigeria
- Department of surgery, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo (AEFUNAI), Ebonyi State, Southeast Nigeria
| | - Daniel A Umezurike
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Southeast Nigeria
| | - Akputa A Obasi
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Southeast Nigeria
| | - Somadina Ikpeze
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria
- Department of Anatomy, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo (AEFUNAI), Ebonyi State, Southeast Nigeria
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Ogbuanya AUO, Ugwu NB, Enemuo VC, Nnadozie UU, Eni UE, Ewah RL, Ajuluchuku UE, Umezurike DA, Onah LN. Emergency laparotomy for peritonitis in the elderly: A Multicentre observational study of outcomes in Sub-Saharan Africa. Afr J Emerg Med 2023; 13:265-273. [PMID: 37790994 PMCID: PMC10542594 DOI: 10.1016/j.afjem.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Background Globally, interest in surgical diseases in the elderly was rekindled recently mainly due to a surge in the aging population and their increased susceptibility to infections. In sub-Saharan Africa, infective diseases are major causes of high morbidity and mortality especially in elderly cohorts, hence this study was set to evaluate current status of this scourge in the elderly in our environment. Aim To document the aetiologic factors and analyze the impact of selected clinical and perioperative indices on mortality and morbidity rates of peritonitis in the elderly. Methods This was a multicenter prospective study involving elderly patients aged 65years and above managed between October 2015 and September 2021 in Southeast Nigeria. Results Of the 236 elderly patients examined, approximately two-third (150, 63.6%) were aged 65-74years. The rest were aged ≥ 75years. There were 142(60.2%) males and 94(39.8%) females. Perforated peptic ulcer (89,37.7%) was the most common cause of peritonitis followed by ruptured appendix (59, 25.0%), then typhoid perforation (44,18.6%). However, typhoid perforation was the deadliest with a crude mortality rate of 40.9%. Overall, morbidity and mortality rates were 33.8% and 28.5% respectively. The main independent predictors of mortality were peritonitis arising from typhoid perforation (p = 0.036), late presentation (p = 0.004), district location of hospital (p = 0.011) and intestinal resection (p = 0.003). Conclusion Generalized peritonitis is a cause of significant morbidity and mortality in the elderly patients in our environment. Perforated peptic ulcer was the most common cause, but typhoid perforation remains the deadliest. Late presentation, district hospital setting and bowel resection were associated with elevated mortality.
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Affiliation(s)
- Aloysius Ugwu-Olisa Ogbuanya
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
- Department of surgery, Bishop Shanahan Specialist Hospital, Nsukka, Enugu state, Nigeria
- Department of Surgery, Mater Misericordie Hospital, Afikpo, Ebonyi State, Nigeria
- Department of Surgery, District Hospital, Nsukka, Enugu State, Nigeria
| | - Nonyelum Benedett Ugwu
- Department of surgery, Bishop Shanahan Specialist Hospital, Nsukka, Enugu state, Nigeria
- Department of Anaesthesia, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Vincent C Enemuo
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of surgery, University of Nigeria, Nsukka, Enugu State, Nigeria
- Department of surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
| | - Ugochukwu U Nnadozie
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
| | - Uche Emmanuel Eni
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
| | - Richard L Ewah
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
- Department of Surgery, Mater Misericordie Hospital, Afikpo, Ebonyi State, Nigeria
- Department of Anaesthesia, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
| | - Uzoamaka E Ajuluchuku
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
| | - Daniel A Umezurike
- Department of surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria
- Department of Surgery, Ebonyi State University, Abakaliki (EBSU), Ebonyi State, Nigeria
| | - Livinus N Onah
- Department of Obstetric and Gynaecology, Enugu State University Teaching Hospital Enugu, Nigeria
- Department of Obstetric and Gynaecology, Enugu State University of Science and Technology, Enugu, Nigeria
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Robinson B, Purcell LN, Reiss R, Msosa V, Mtalimaja O, Charles A. Reasons for in-hospital delays to emergency surgical care in a resource-limited setting: Surgery versus anesthesiology perspective. Trop Doct 2023; 53:66-72. [PMID: 35892158 DOI: 10.1177/00494755221100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients experience delays in emergency surgical care. Our 3-month mixed-methods observational prospective study examined the duration of in-hospital delays (IHDs) to emergency surgery at a tertiary hospital in Malawi and perceived reasons for such delay, assessing the correlation between surgery and anesthesia. Delays over two hours occurred in the majority, and almost 20% waited over twelve hours. However, we found no correlation between surgeons and anaesthetists in the perceived reasons for In-hospital delays to emergency surgical care.
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Affiliation(s)
- Brittany Robinson
- School of Medicine, 8785University of California San Francisco, San Francisco, CA, USA
| | - Laura N Purcell
- Department of Surgery, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Anthony Charles
- Department of Surgery, 2331University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,291053Kamuzu Central Hospital, Lilongwe, Malawi
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Mulder WW, Arko-Cobbah E, Joubert G. Are admission laboratory values in isolation meaningful for predicting surgical outcome in patients with perforated peptic ulcers? Surg Open Sci 2022; 11:62-68. [PMID: 36570627 PMCID: PMC9768370 DOI: 10.1016/j.sopen.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/10/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Background The study aimed to calculate the predictive value of admission laboratory values in patients with perforated peptic ulcers. Methods A retrospective, cohort analytical, observational study was performed, including patients with surgically confirmed perforated peptic ulcers over a 5-year period. Demographic data and admission laboratory values were collected from hospital electronic databases. Outcomes measured were in-hospital mortality, intensive care unit (ICU) admission and length of stay. The significance of categorical variables was calculated by chi-square and Fisher's exact test. Logistic regression analysis was performed to determine univariately statistically significant variables. Results In total, 188 patients met the inclusion criteria. The median age was 46 (range 15-87) years with a male predominance of 71.3 % (n = 134). The median length of hospital stay was 7 (range 1-94) days and 31.4 % (n = 59) of patients were admitted to the ICU. Post-operative in-hospital mortality was 25.0 % (n = 47). Predicting the categorical outcome of in-hospital mortality, abnormal haemoglobin, platelet count, urea, creatinine and potassium levels were all found to be statistically significant in the univariate analysis. Age (odds ratio [OR] 1.03), haemoglobin (OR 4.36) and creatinine (OR 7.76) levels were significant in the multivariate analysis. Conclusions Mortality rate among patients with perforated peptic ulcer disease is still substantial. Admission laboratory values showed statistical significance as outcome indicators and were valuable to assist in predicting the prognosis. An abnormally high serum creatinine level was the strongest single predictor of both mortality and ICU admission. Key message Initial laboratory findings of patients admitted for perforated peptic ulcer showed that an abnormally high serum creatinine level was the strongest single predictor of both mortality and ICU admission.
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Affiliation(s)
- Wikus W. Mulder
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa,Corresponding author at: Department of Surgery, Faculty of Health Sciences, University of the Free State, 2015 Nelson Mandela Drive, Bloemfontein 9300, South Africa.
| | - Emmanuel Arko-Cobbah
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Gina Joubert
- Department of Biostatistics, School of Biomedical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Seyoum N, Ethicha D, Assefa Z, Nega B. Risk Factors that Affect Morbidity and Mortality in Patients with Perforated Peptic Ulcer Diseases in a Teaching Hospital. Ethiop J Health Sci 2021; 30:549-558. [PMID: 33897215 PMCID: PMC8054450 DOI: 10.4314/ejhs.v30i4.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background This study was done to identify risk factors that affect the morbidity and mortality of patients operated for a perforated peptic ulcer in a resource-limited setting. Methods A two years (January 1, 2016 -December 30, 2018) retrospective cross-sectional study was done on patients admitted and operated for PPU at Yekatit 12 Hospital, Addis Ababa, Ethiopia. Results A total of 93 patients were operated. The median age affected was 29 years (Range 15–75 years). Male to female ratio was 7.5:1. Chewing chat, smoking and alcohol use were seen in 22 (23.6%), 35(37.6%), and 34(36.5%), cases respectively. Only 23.6% gave previous history of dyspepsia. The median duration of illness was 48hours and the duodenal to gastric ulcer perforation ratio was 6.5:1. In majority of the cases (63.3%) the perforation diameter was =10mm (63.3%). Cellan-Jones repair of the perforations was done in 92.5% of cases. A total of 47 complications were seen in 25 cases. The total complications and mortality rates were 25(26.8%) and 6(6.5%) respectively. The most common postoperative complication was pneumonia (13.97%) followed by superficial surgical site infection (10.8%). Mortality rate was highest among patients >50yrs [AOR (95%CI) =2.4(230)]. Delayed presentation of >24 hours [AOR (95%CI) =4.3(1.4–13.5)] and a SBP =90mmhg [AOR (95%CI) =4.8(1–24)] were found to be significantly related with higher complication rate. Conclusions Patients who presented early and immediate corrective measures were instituted had better outcomes while those seen late developed unfavorable out-come with significantly higher complications. Therefore, early detection and treatment of PPU is essential.
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Affiliation(s)
- Nebyou Seyoum
- Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Daba Ethicha
- Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Zelalem Assefa
- Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Berhanu Nega
- Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
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Akgunduz F, Sozutek A, Irkorucu O, Yaman A. The Adjunctive Effect of DuraSeal® vs. 2-Octyl-Cyanoacrylate on Delayed Repair of Gastric Perforation: An Experimental Study. J INVEST SURG 2021; 35:542-548. [PMID: 33645439 DOI: 10.1080/08941939.2021.1887414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Delayed primary suture closure of gastric perforation is prone to dehiscence hence the repaired area should be buttressed to avoid re-operation. We aimed to investigate whether DuraSeal®(DS) has a potent adjunctive effect on delayed closure of gastric perforation comparing with 2-octly-cyanoacrylate(CYN) in an experimental model. METHODS Sixty rats were randomly divided into 6 groups. All subjected to gastric perforation, subsequently perforation areas were repaired by primary suturing, delayed repair was performed 12 h after surgery. According to DS or CYN application on anastomosis, the groups were classified as control(C), delayed control(CD), closure with CYN(CYN), delayed closure with CYN(D-CYN), closure with DS(DS), delayed closure with DS(D-DS).After euthanization on POD 7,anastomotic bursting pressure(ABP) were measured. Tissue samples were taken for histopathological examination and hydroxyproline(TH) assessment. RESULTS Delayed condition significantly reduced ABP and TH levels in CD group comparing with all groups(p < 0.01).Either CYN or DS application on delayed repaired area significantly raised the measure of ABP and TH up to the levels of C group(p < 0.05,comparing with CD).Microscopically,either CYN or DS application significantly improved tissue necrosis, submucosal bridging and collagen formation comparing with CD group(p < 0.012).There were no difference regarding ABP, TH and tissue healing between each CYN and DS groups. CONCLUSION DuraSeal® application on sutured gastric perforation area yielded a significant adjunctive effect both in normal and delayed conditions. However, DuraSeal® revealed no superior effect to CYN in both condition.Our results demonstrated that the clinical use of DuraSeal® can be considered for reinforcing the sutured line in patients undergoing delayed surgery for gastric perforation.
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Affiliation(s)
- Fatih Akgunduz
- General Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
| | - Alper Sozutek
- Gastroenterological Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
| | - Oktay Irkorucu
- General Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
| | - Abit Yaman
- General Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
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Teshome H, Birega M, Taddese M. Perforated Peptic Ulcer Disease in a Tertiary Hospital, Addis Ababa, Ethiopia: Five Year Retrospective Study. Ethiop J Health Sci 2020; 30:363-370. [PMID: 32874079 PMCID: PMC7445938 DOI: 10.4314/ejhs.v30i3.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Peptic ulcer perforation is one of the two major acute complications of peptic ulcer disease with significant morbidity and mortality. Methods Institution based retrospective review was done to determine patient presentation, management and postoperative complications of perforated peptic ulcer disease (PPUD) at a tertiary hospital in Addis Ababa, Ethiopia. Patients operated on from January 2013 to December 2017 were included. Univalent analysis was used to determine the influence of patient and operative events on postoperative outcomes. Result Totally, 136 patients were studied. Males outnumbered females by a ratio of 5.5:1. The mean age of patients was 36.05±16.56 years. Seventy-one (52.2%) patients presented after twenty-four hours of onset of symptoms. Most perforations were located on the first part of the duodenum (117,86%). There were 73 postoperative complications recorded in 31(22.8%) patients. Old age, being female, presence of comorbidity, hypotension, tachycardia, and delayed presentation were significantly associated with postoperative morbidity (P<0.05). Nine (6.6%) patients died at the hospital. Mortality was significantly associated with old age, comorbid illness, tachycardia, and development of post-operative complications (P<0.05). The postoperative hospital stay of the patients with complications was 18.6 ± 14.7 days which was significantly higher than that of patients without complication 6.7±2.7days (P=0.001). Conclusion Old age, being female, presence of comorbidity, hypotension, tachycardia, and delayed presentation were significantly associated with postoperative morbidity. Old age, comorbid illness, tachycardia and development of post-operative complications were found to increase the risk of mortality.
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Affiliation(s)
- Henok Teshome
- Assistant Professor of Surgery, St. Paul's Hospital Millennium Medical College (SPHMMC)
| | - Mekbib Birega
- Assistant Professor of Surgery, Arbaminch University
| | - Mekdim Taddese
- Assistant Professor of Surgery, St. Paul's Hospital Millennium Medical College (SPHMMC)
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Purcell LN, Robinson B, Msosa V, Gallaher J, Charles A. District General Hospital Surgical Capacity and Mortality Trends in Patients with Acute Abdomen in Malawi. World J Surg 2020; 44:2108-2115. [PMID: 32166470 PMCID: PMC7292121 DOI: 10.1007/s00268-020-05468-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The burden of emergency general surgery conditions is high in sub-Saharan Africa, and poor access to surgical care leads to poor patient outcomes. We examined the trends in mortality in patients presenting with an acute abdomen to a referral hospital. METHODS A retrospective analysis of the prospectively collected Kamuzu Central Hospital Acute Care Surgery database was performed (January 2014 to July 2019). Bivariate analysis was conducted by year of admission. A multivariate Poisson regression was performed to identify predictors of mortality. RESULTS During the study, 2509 patients with acute abdomen presented. The majority of patients presenting were transferred from outside hospitals (n = 2097, 83.9%). Mortality was highest in patients with preoperative diagnosis of peritonitis (n = 119, 22.2%), bowel obstruction (n = 214, 18.7%), and volvuli (n = 51, 18.6%). There was no difference in mortality by year, p = 0.1. On multivariate Poisson regression, there was an increased relative risk of mortality with being transferred (RR 1.31, 95% CI 1.12-1.55, p = 0.002), as well as undergoing an operation within 1-2 days (RR 1.48, 95% CI 1.16-1.87, p < 0.001) and >2 days (RR 1.46, 95% CI 1.17-1.82, p = 0.001) after presentation. CONCLUSION The majority of patients in our study who presented with an acute abdomen were transferred from district hospitals, which resulted in high mortality due to delays in surgical care. Therefore, the WHO's recommendation that the majority of district hospitals perform the Bellwether procedures does not occur in district hospitals in central Malawi. District hospitals require significant resource investment to reduce transfers needs and patient mortality.
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Affiliation(s)
- Laura N Purcell
- Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, USA
| | - Brittany Robinson
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Jared Gallaher
- Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, USA
| | - Anthony Charles
- Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, USA.
- Kamuzu Central Hospital, Lilongwe, Malawi.
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Bupicha JA, Gebresellassie HW, Alemayehu A. Pattern and outcome of perforated peptic ulcer disease patient in four teaching hospitals in Addis Ababa, Ethiopia: a prospective cohort multicenter study. BMC Surg 2020; 20:135. [PMID: 32539756 PMCID: PMC7296920 DOI: 10.1186/s12893-020-00796-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perforated peptic ulcer disease is a surgical emergency with a high morbidity and mortality. The socio-demographic characteristic and the factors associated with morbidity and mortality seems to differ between the developed and developing world. This is the first a prospective cohort study in Ethiopia designed to analyze pattern and outcome of patients with perforated peptic ulcer disease in four teaching hospitals affiliated with SOM, CHS of Addis Ababa University. METHOD This is a prospective cohort study of patients operated for perforated peptic ulcer disease from June 1, 2018 to May 31, 2019 in four teaching hospital affiliated to department of surgery of SOM, CHS of Addis Ababa university. RESULT A total of 97 patients were operated in a year. 86.6% were males with a male to female ratio of 6.5:1. The age group 21-30 were most affected constituting 42.3% of all patients. Mean age is 31.9, Median of 27, age ranges from 16 to 76. Alcohol use (45.4%) and previous history of ulcer disease (75.3%) were the most prevalent risk factors.33% were smokers. Abdominal was present in all and most presented within 48 h (79.4%). 85.6% had pneumo = peritoneum in an x-ray at presentation. Size of the perforation is 10 mm or less in 81.3%. 91(93.8%) had anterior first part duodenum perforation. Repair with pedicled omental patch was done in 65 (67.1%) patients. Age, duration of presentation, hypotension at presentation, size of perforation, degree of peritoneal contamination were found to be the significant factors for morbidity and mortality. Major morbidities were observed in 16 (16.5%) and mortality occurred in 3 (3.1%) patients. CONCLUSION Perforation of peptic ulcer disease here occurs in the young. Age, duration of presentation, hypotension at presentation, size of perforation, degree of peritoneal contamination were found to be the significant factors for morbidity and mortality. Morbidity and mortality rate of 16.5 and 3.1% observed here are quite acceptable.
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Maine RG, Kajombo C, Purcell L, Gallaher JR, Reid TD, Charles AG. Effect of in-hospital delays on surgical mortality for emergency general surgery conditions at a tertiary hospital in Malawi. BJS Open 2019; 3:367-375. [PMID: 31183453 PMCID: PMC6551403 DOI: 10.1002/bjs5.50152] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/22/2019] [Indexed: 12/14/2022] Open
Abstract
Background In sub‐Saharan Africa, surgical access is limited by an inadequate surgical workforce, lack of infrastructure and decreased care‐seeking by patients. Delays in treatment can result from delayed presentation (pre‐hospital), delays in transfer (intrafacility) or after arrival at the treating centre (in‐hospital delay; IHD). This study evaluated the effect of IHD on mortality among patients undergoing emergency general surgery and identified factors associated with IHD. Methods Utilizing Malawi's Kamuzu Central Hospital Emergency General Surgery database, data were collected prospectively from September 2013 to November 2017. Included patients had a diagnosis considered to warrant urgent or emergency intervention for surgery. Bivariable analysis and Poisson regression modelling was done to determine the effect of IHD (more than 24 h) on mortality, and identify factors associated with IHD. Results Of 764 included patients, 281 (36·8 per cent) had IHDs. After adjustment, IHD (relative risk (RR) 1·68, 95 per cent c.i. 1·01 to 2·78; P = 0·045), generalized peritonitis (RR 4·49, 1·69 to 11·95; P = 0·005) and gastrointestinal perforation (RR 3·73, 1·25 to 11·08; P = 0·018) were associated with a higher risk of mortality. Female sex (RR 1·33, 1·08 to 1·64; P = 0·007), obtaining any laboratory results (RR 1·58, 1·29 to 1·94; P < 0·001) and night‐time admission (RR 1·59, 1·32 to 1·90; P < 0·001) were associated with an increased risk of IHD after adjustment. Conclusion IHDs were associated with increased mortality. Increased staffing levels and operating room availability at tertiary hospitals, especially at night, are needed.
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Affiliation(s)
- R. G. Maine
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - C. Kajombo
- Department of SurgeryKamuzu Central HospitalLilongweMalawi
| | - L. Purcell
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - J. R. Gallaher
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - T. D. Reid
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - A. G. Charles
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Hernandez MC, Thorn MJ, Kong VY, Aho JM, Jenkins DH, Bruce JL, Laing GL, Zielinski MD, Clarke DL. Validation of the AAST EGS grading system for perforated peptic ulcer disease. Surgery 2018; 164:738-745. [PMID: 30082138 DOI: 10.1016/j.surg.2018.05.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Perforated peptic ulcer disease (PPUD) including both duodenl and gastric ulcers is a severe disease and outcomes are influenced by comorbidities and physiology. We validated the AAST EGS grading system at two diverse centers (Mayo Clinic, USA and Pietermaritzburg, South Africa). METHODS Dual-center review of historic data (2010-2016) of adults with PPUD was performed. Preoperative, procedural, and postoperative data were abstracted. ASA, Boey, PULP and AAST EGS grades were generated. Comparative, multivariable, and pairwise analyses were performed. RESULTS There were 306 patients, 42% female with a mean (±SD) age of 56 ±20 years. Overall, the patints were categorized into the following AAST EGS grades: I (30, 10%), II (38, 12%), III (104, 34%), IV (76, 2e%), V (58, 18.9%). Initial management included: midline laparotomy (51%, n=157), laparoscopy (18%, n=58), laparoscopy converted to laparotomy (1%, n=3), and endoscopy (30%, n=88). Duration of stay increased with AAST EGS grade. In United States cohort, factors predictive for 30-day mortality included AAST EGS grade and patient comorbidity status. The AAST EGS grade was comparable to other scoring systems (Boey, PULP, and ASA). CONCLUSIONS Differences exist between centers for management of PPUD and their outcomes; however, the AAST EGS grade can be utilized to stratify thedisease severity of the patient and this demonstrates initial construct validity in a United States but not in a South African population.
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Affiliation(s)
- Matthew C Hernandez
- Division of Trauma Critical Care and General Surgery, Department of Surgery, Rochester, MN 55905.
| | - Michael J Thorn
- Division of Trauma Critical Care and General Surgery, Department of Surgery, Rochester, MN 55905.
| | - Victor Y Kong
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa.
| | - Johnathon M Aho
- Division of Trauma Critical Care and General Surgery, Department of Surgery, Rochester, MN 55905.
| | - Donald H Jenkins
- Division Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - John L Bruce
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa.
| | - Grant L Laing
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa.
| | - Martin D Zielinski
- Division of Trauma Critical Care and General Surgery, Department of Surgery, Rochester, MN 55905.
| | - Damian L Clarke
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa.
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A Five-Year Review of Perforated Peptic Ulcer Disease in Irrua, Nigeria. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2017; 2017:8375398. [PMID: 28656171 PMCID: PMC5471598 DOI: 10.1155/2017/8375398] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/03/2017] [Indexed: 02/07/2023]
Abstract
Background Peptic ulcer perforation is a common cause of emergency admission and surgery. This is the first study that documents the presentation and outcome of management in Irrua, Nigeria. Patients and Method This is a prospective study of all patients operated on for perforated peptic ulcer between April 1, 2010, and March 31, 2015. A structured questionnaire containing patients' demographics, operation findings, and outcome was filled upon discharge or death. Results There were 104 patients. 81 males and 23 females (M : F = 3.5 : 1). The age range was between 17 years and 95 years. The mean age was 48.99 years ± SD 16.1 years. The ratio of gastric to duodenal perforation was 1.88 : 1. Perforation was the first sign of peptic ulcer disease in 62 (59.6%). Pneumoperitoneum was detectable with plain radiographs in 95 (91%) patients. 72 (69.2%) had Graham's Omentopexy. Death rate was 17.3%. Conclusion We note that gastric perforation is a far commoner disease in our environment. Perforation is often the first sign of peptic ulcer disease. We identify fasting amongst Christians as a risk factor for perforation.
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