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Tsehay YT, Bogale AD, Mulatu S, Netsere HB, Adal O, Messelu MA, Mamo ST, Demile TA, Abebe GK, Mekonnen GB, Belay AE, Wondie WT, Belayneh AG. Magnitude and associated factors of postoperative mortality among patients who underwent surgery in Ethiopia: systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:2940-2950. [PMID: 38694295 PMCID: PMC11060307 DOI: 10.1097/ms9.0000000000001978] [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: 02/16/2024] [Accepted: 03/01/2024] [Indexed: 05/04/2024] Open
Abstract
Background Postoperative mortality is one of the six surgical indicators identified by the Lancet Commission on Global Surgery for monitoring access to high-quality surgical care. This study aimed to assess the magnitude and associated factors of postoperative mortality among patients who underwent surgery in Ethiopia. Methods This systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Ten studies were included in this Systematic review and meta-analysis. The risk of bias for each study was assessed using the Joanna Briggs Institute quality appraisal scale. Publication bias was checked using a funnel plot and Egger's regression test. Heterogeneity across studies was assessed by I2 statistics. STATA version 17 software was used for analysis. A random effect model and the DerSimonian-Laird method of estimation was used to estimate the pooled magnitude of postoperative mortality. Odds ratios with 95% CIs were calculated to determine the associations of the identified factors with postoperative mortality. Results The results revealed that the pooled magnitude of postoperative mortality among patients who underwent surgery in Ethiopia was 4.53% (95% CI :3.70-5.37). An American Society of Anesthesiologists score greater than or equal to III [adjusted odds ratio (AOR): 2.45, 95% CI: 2.02, 2.96], age older than or equal to 65 years (AOR: 3.03, 95% CI: 2.78, 3.31), and comorbidity (AOR: 3.28, 95% CI: 1.91, 5.63) were significantly associated with postoperative mortality. Conclusion and recommendations The pooled magnitude of postoperative mortality among patients who underwent surgery in Ethiopia was high. The presence of comorbidities, age older than 65 years, and ASA physical status greater than III were significantly associated with postoperative mortality. Therefore, the Ministry of Health and other concerned bodies should consider quality improvement processes.
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Affiliation(s)
| | | | | | | | - Ousman Adal
- Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar
| | - Mengistu Abebe Messelu
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos
| | - Sosina Tamre Mamo
- Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar
| | - Tiruye Azene Demile
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar
| | - Gebremeskel Kibret Abebe
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Woldia University, Woldia
| | - Gebrehiwot Berie Mekonnen
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor
| | | | - Wubet Tazeb Wondie
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Asnake Gashaw Belayneh
- Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar
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Long D, Mao C, Liu Y, Zhou T, Xu Y, Zhu Y. Global, regional, and national burden of intestinal obstruction from 1990 to 2019: an analysis from the Global Burden of Disease Study 2019. Int J Colorectal Dis 2023; 38:245. [PMID: 37787806 DOI: 10.1007/s00384-023-04522-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Intestinal obstruction (IO) is a common surgical acute abdominal condition that places a significant burden on modern health systems. Unfortunately, the global burden and trends of IO remain unknown. Therefore, this study aimed to comprehensively assess its long-term trends and epidemiological features, which will help policymakers to formulate appropriate health policies. METHODS We conducted an ecological study using data from the Global Burden of Disease Study (GBD) 2019. Data on IO were analyzed by sex, age, year, sociodemographic index (SDI), and location according to GBD 2019. In addition, joinpoint regression analysis was used to assess temporal trends. Age-period-cohort analysis (APC Analysis) was conducted to evaluate age, period, and birth cohort effects on IO incidence and mortality risk. RESULTS Globally, the prevalent and incident cases increased by 56.91% and 86.67% from 1990 to 2019, respectively. Joinpoint regression analysis showed that age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) increased, but age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year (DALY) rate decreased over the past three decades. The age effect demonstrated that older people have a higher risk of morbidity and mortality. The period effect of incidence and mortality showed an upward trend from 1990 to 2019. Cohort effect revealed that the incidence and death risk peaked in the earlier-born cohort and was lower in the more recent-born cohort. Notably, we found that the burden of IO was higher in males than in females throughout the study period. There are huge disparities in IO burden among countries. CONCLUSION Globally, the reported incidence and prevalence of IO increased from 1990 to 2019. The burden of IO differed markedly by age, sex, country, and region. Middle-aged and elderly people over 50 years old were at high risk. Given the ageing population, the burden of IO will be a major public health challenge. Thus, there is a strong necessity to strengthen prevention and early intervention in the at-risk population.
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Affiliation(s)
- Dan Long
- The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Chenhan Mao
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yaxuan Liu
- The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Tao Zhou
- The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Yin Xu
- The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China.
| | - Ying Zhu
- The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China.
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Shama AT, Terefa O, Gadisa I, Feyera G, Tamiru G, Terefa DR, Merdassa E. Surgical management outcome and its associated factors among intestinal obstruction patients admitted to adult surgical ward of Wollega University Referral Hospital, Ethiopia. BMC Surg 2023; 23:136. [PMID: 37198591 DOI: 10.1186/s12893-023-02043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 05/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Globally, bowel obstruction is the most common cause of surgical emergencies. It remains a challenge to healthcare workers in spite of improvements in management techniques. There is a lack of the study to determine the surgical management outcome and its associated factors in the area of study. Hence, this study aimed to determine management outcome and its associated factors among surgically treated intestinal obstruction patients at Wollega University Referral Hospital, 2021. METHODS Facility-based cross-sectional study was conducted among all cases surgically managed for intestinal obstruction between September 1, 2018 and September 1, 2021. Data were collected using a structured checklist. The collected data were checked for completeness and entered into data entry software and then exported to SPSS version 24 for data cleaning and analysis. Both bi-variable and multivariable logistic regressions were run. P-value < 0.05 was used to declare a statistically significant association in multivariable logistic regression. The odds ratio along with 95%CI was estimated to measure the strength of the association. RESULT 116 (59.2%) patients had favorable surgical management outcome for intestinal obstruction. Male sex (AOR = 3.694;95%CI:1.501,9.089), absence of fever (AOR = 2.636; 95%CI:1.124,6.18), ≤ 48 h duration of illness before operation (AOR = 3.045; 95%CI:1.399,6.629), viable intraoperative bowel condition (AOR = 2.372; 95%CI:1.088, 5.175), having bowel resection and anastomosis (AOR = 0.234; 95%CI:0.101,0.544) were the significantly associated factors of the favorable surgical management outcome for intestinal obstruction. CONCLUSION AND RECOMMENDATION The favorable management outcome of patients with intestinal obstruction who were treated surgically in this study was low. Factors like sex, fever, short duration of illness, viable intraoperative bowel condition, and bowel resection and anastomosis were found to influence the surgical management outcome of patients with intestinal obstruction. The patient with intestinal obstruction should seek health care on time. Health professionals have to be skilled and provide appropriate care for the patients to reduce the risk of complications.
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Affiliation(s)
- Adisu Tafari Shama
- Department of public health, Institute of health sciences, Wollega University, Nekemte, Ethiopia.
| | - Olana Terefa
- School of Medicine, Institute of health sciences, Wollega University, Nekemte, Ethiopia
| | - Iyasu Gadisa
- School of Medicine, Institute of health sciences, Wollega University, Nekemte, Ethiopia
| | - Gemechu Feyera
- School of Medicine, Institute of health sciences, Wollega University, Nekemte, Ethiopia
| | - Getnet Tamiru
- School of Medicine, Institute of health sciences, Wollega University, Nekemte, Ethiopia
| | - Dufera Rikitu Terefa
- Department of public health, Institute of health sciences, Wollega University, Nekemte, Ethiopia
| | - Emiru Merdassa
- Department of public health, Institute of health sciences, Wollega University, Nekemte, Ethiopia
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Adane F, Dessalegn M. Magnitude and predictors of unfavorable management outcome in surgically treated patients with intestinal obstruction in Ethiopia: a systematic review and meta-analysis. BMC Surg 2023; 23:132. [PMID: 37193961 DOI: 10.1186/s12893-023-02017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/26/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Unless an emergency surgical intervention is conducted, intestinal obstruction may result in high morbidity and mortality. In Ethiopia, the magnitude and predictors of unfavorable management outcomes in surgically treated patients with intestinal obstruction are highly variable and inconsistent. The aim of this study was; therefore, to estimate the overall prevalence of unfavorable management outcome and its predictors among surgically treated patients with intestinal obstruction in Ethiopia. METHOD We searched articles from databases from June 1, 2022, to August 30, 2022. Cochrane Q test statistics and I2 tests were applied. We used a random-effect meta-analysis model to overcome the impact of heterogeneity among the included studies. In addition, the association between risk factors and unfavorable management outcome in surgically treated patients with intestinal obstruction was investigated. RESULTS This study included a total of twelve articles. The pooled prevalence of unfavorable management outcome in surgically treated patients with intestinal obstruction was 20.22% (95% CI: 17.48-22.96). According to a sub-group analysis by region, Tigray region had the highest prevalence of poor management outcome, which was 25.78% (95% CI: 15.69-35.87). Surgical site infection was the most commonly reported symptom of poor management outcome (8.63%; 95% CI: 5.62, 11.64). The length of postoperative hospital stays (95% CI: 3.02, 29.08), duration of illness (95% CI: 2.44, 6.12), presence of comorbidity (95% CI: 2.38, 10.11), dehydration (95% CI: 2.07, 17.40), and type of intraoperative procedure (95% CI: 2.12, 6.97) were all significantly associated with unfavorable management outcome of intestinal obstruction among surgically treated patients in Ethiopia. CONCLUSION According to this study, the magnitude of unfavorable management outcome was high among surgically treated patients in Ethiopia. Unfavorable management outcome was significantly associated with the length of postoperative hospital stays, duration of illness, comorbidity, dehydration, and type of intraoperative procedure. Medical, surgical and public health measures are pivotal to reduce unfavorable management outcome in surgically treated intestinal obstruction patients in Ethiopia.
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Affiliation(s)
- Fentahun Adane
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia.
| | - Megbar Dessalegn
- Department of Surgery, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
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Batebo M, Loriso B, Beyene T, Haile Y, Hailegebreal S. Magnitude and determinants of treatment outcome among surgically treated patients with intestinal obstruction at Public Hospitals of Wolayita Zone, Southern Ethiopia: a cross sectional study, 2021. BMC Surg 2022; 22:121. [PMID: 35354458 PMCID: PMC8969308 DOI: 10.1186/s12893-022-01568-1] [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: 12/08/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Procedures to treat intestinal obstruction range from minimally invasive laparoscopic surgery to more complicated open surgical procedures. It may end with high morbidity and mortality because of different reasons. It is very important to know about the determinants of favorable outcome of surgical management for intestinal obstruction however, little is known about this problem at public hospitals of Southern Ethiopia. Methods Facility based cross sectional study was conducted. A total of 230 medical records which fulfill the inclusion criteria were used for this study. Variables with p value of less than 0.25 in the bivariate analysis were entered in multivariable logistic regression to control confounding. Finally, odds ratio with 95% confidence interval was used to identify variables which were significantly associated with dependent variable. Results According to this study the magnitude of favorable surgical management outcome of intestinal obstruction was 177(77.0%) [95% CI, 71.4, 82.4]. Having small bowel obstruction (AOR = 2.49) [95% CI 1.91, 5.12], having simple bowel obstruction (AOR = 4.32) [95% CI, 2.00, 9.35], early presentation of patients (AOR = 4.44) [95% CI, 1.99, 9.92] and intraoperative procedure other than resection and anastomosis was performed (AOR = 0.45) [95% CI, 0.21, 0.96] were significantly associated with favorable outcome among surgically treated patients. Conclusion The overall magnitude of favorable surgical management outcome of intestinal obstruction was moderate compared to other study. Having small bowel obstruction, having simple bowel obstruction, other procedure other than resection and anastomosis done, and early presentation of patients were significant predictors. Physicians should diagnose intestinal obstruction early and appropriate interventions should be taken on time before the complication happened. On time consultation and decision at the hospital setting is also recommended.
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Affiliation(s)
- Muhaba Batebo
- Homecho Primary Hospital, Gibe District, Southern Ethiopia, Ethiopia
| | - Bereket Loriso
- College of Medicine and Health Sciences, School of Medicine, Wolayita Sodo University, Wolayita Sodo, Ethiopia
| | - Tilahun Beyene
- College of Medicine and Health Sciences, Wachamo University, School of Public Health, Hossana, Ethiopia
| | - Yosef Haile
- College of Medicine and Health Sciences, Arba Minch University, School of Public Health, Arba Minch, Ethiopia.
| | - Samuel Hailegebreal
- Department of Health Informatics, College of Medicine and Health Science, School of Public Health, Arba Minch University, Arba Minch, Ethiopia
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