Department of Surgery, University of KwaZulu-Natal, South Africa.
Department of Surgery, University of KwaZulu-Natal, South Africa.
J Surg Res. 2021 Jun;262:65-70. doi: 10.1016/j.jss.2020.12.062. Epub 2021 Feb 3.
Nontraumatic surgical emergencies constitute a significant portion of total surgical workload and are associated with a significant mortality rate. The spectrum and outcome of surgical emergencies in a low-middle-income country may differ from that in high-income countries. This study aims to describe the spectrum and outcome of emergency laparotomy for nontrauma surgical emergencies at a single-tertiary center in South Africa.
A retrospective interrogation of a hybrid electronic record system of consecutive patients undergoing emergency laparotomy for nontraumatic surgical emergencies presenting to Greys Hospital from December 2012 to December 2018.
One thousand four hundred sixty four patients were included with a median age of 34 y (IQR 23-52) and male predominance (861; 59%). The mortality rate was 12.5% (183). The most common comorbidity was human immunodeficiency virus (353; 24.1%) which did not influence mortality. At least one comorbidity increased the odds of mortality by 4 times (95% CI 2.7-6.2). Mortality was associated with longer waiting times to operation (12.8 versus 8.4 h; P < 0.001) and longer operating times (105 min versus 80 min respectively; P < 0.001). Temporary abdominal closure was used in 245 (16.7%) patients. Planned repeat laparotomy was performed in 193 (13.2%) patients. Acute appendicitis (594, 40.6%) was the most common pathology of which 61.4% had the American Association for the Surgery of Trauma grade of 4 or more (high grade). This was followed by perforated peptic ulcer disease (10.5%). The adverse event rate was 51.5% (754). Postoperative pulmonary complications and acute kidney injury were the most common. The strongest predictors of mortality were abdominal compartment syndrome (OR 26.5, 95% CI 9.36-94.13) and postoperative hemodynamic instability 17.43 (OR 17.4, 95% CI 11.80-25.98).
Our spectrum of disease differs to that found in high-income countries. The morbidity and mortality rates are significant, and attention must be focused on attempts to reduce this. Various comorbidities and adverse events are associated with increased mortality.
非创伤性外科急症构成了全部外科工作量的重要组成部分，并与高死亡率相关。中低收入国家的外科急症谱和结局可能与高收入国家不同。本研究旨在描述南非一家三级医院因非创伤性外科急症行急诊剖腹术的患者的急症谱和结局。
对 2012 年 12 月至 2018 年 12 月在格雷厄姆斯医院就诊的非创伤性外科急症患者的连续电子记录系统进行回顾性查询。
共纳入 1464 例患者，中位年龄为 34 岁（IQR 23-52），男性居多（861 例，59%）。死亡率为 12.5%（183 例）。最常见的合并症是人类免疫缺陷病毒（HIV）（353 例，24.1%），但并不影响死亡率。至少有一种合并症使死亡率增加 4 倍（95%CI 2.7-6.2）。死亡率与手术等待时间延长（12.8 小时与 8.4 小时；P<0.001）和手术时间延长（分别为 105 分钟与 80 分钟；P<0.001）相关。245 例（16.7%）患者采用了临时腹部闭合术。193 例（13.2%）患者计划进行再次剖腹术。急性阑尾炎（594 例，40.6%）是最常见的病理类型，其中 61.4%的患者美国外科创伤协会（American Association for the Surgery of Trauma，AAST）分级为 4 级或更高级别（高级别）。其次是穿孔性消化性溃疡病（10.5%）。不良事件发生率为 51.5%（754 例）。术后肺部并发症和急性肾损伤是最常见的并发症。死亡的最强预测因素是腹腔间隔室综合征（OR 26.5，95%CI 9.36-94.13）和术后血流动力学不稳定（OR 17.4，95%CI 11.80-25.98）。
我们的疾病谱与高收入国家不同。发病率和死亡率都很高，必须集中精力努力降低这两个指标。各种合并症和不良事件与死亡率增加相关。
