RISK FACTORS FOR READMISSION AND LENGTH OF INPATIENT STAY IN RURAL GHANA FOLLOWING EXPLORATORY LAPAROTOMY.

BACKGROUND

Increased inpatient length of stay (LOS) and readmission represent significant economic burden on patients and families faced with surgical disease in low-middle income countries given limited surgical access, infrastructure, and variable insurance status.

STUDY AIM

Identify risk factors for readmission and inpatient LOS in postoperative care in the Eastern Regional Hospital, Ghana.

STUDY DESIGN

Retrospective case series.

SETTING

Eastern Regional Hospital, Koforidua, Ghana.

METHODS

Data for exploratory laparotomy procedures were obtained from surgical case logs collected at the regional referral hospital in Koforidua, Eastern Region, Ghana from July 2017 to June 2018. This information was combined with the hospital electronic medical records to collect demographic data, laboratory values, and outcomes. Multivariable analyses were used to model LOS and readmission.

RESULTS

The study included 346 exploratory laparotomy procedures (286 adult, 60 pediatric) for various surgical diseases. The overall 30-day readmission rate was 9.2%. Average LOS was 12.0±20.4 days for readmitted patients and 6.7±5.5 days for patients without readmission. Readmitted patients were more likely to have had preoperative anemia (p=0.009), surgical site infection (=0.001), or a re-laparotomy (p=0.005). Preoperative anemia (OR=3.5 [95% CI 1.54-7.96], p=0.003) and surgical site infection (OR=3.68 [95% CI 1.36-10.00], p=0.011) were associated with increased odds of readmission. Preoperative anemia was also associated with about 3.0 additional inpatient days (p=0.001).

CONCLUSION

Preoperative anemia and surgical site infections represent risk factors for readmission in rural Ghana. Anemia is also associated with longer LOS. Future interventions aimed at treating anemia and preventing surgical site infections may reduce some of the post-operative burden placed on patients and their families.