Zafar Muhammad H, Zaka Ur Rehman Taha A, Khan Muhammad Sohaib, Ahmed Shayan, Shariff Amir
Surgery, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2022 Aug 2;14(8):e27592. doi: 10.7759/cureus.27592. eCollection 2022 Aug.
Introduction In-patient delay is associated with increased mortality in patients with alimentary tract perforations. Access to surgical care is a glaring health issue in low-middle income countries (LMICs), where patient presentation is also delayed for a myriad of reasons, which can be broadly categorized as social/cultural, financial, and structural in their nature. The impact these delays have on surgical outcomes in low-middle income countries is not known. Methods A retrospective cohort study of patients who underwent emergency laparotomy for alimentary tract perforation from July 2015 to June 2018 was conducted at a tertiary care hospital in Karachi, Pakistan. Time was recorded in two variables: symptom onset to emergency room presentation (ERT) and emergency room to operation room time (ORT). Results Overall, 80 patients were included in the study. The 12 (15%) patients who expired were significantly older (57 ± 17.7 years of age), had a higher Charlson Comorbidity Index and had longer ORT [median ORT in hours-discharged vs expired: 8.2 (IQR 5-15) vs 16 (IQR 12-28) p=0.02]. ERT was also longer but lacked statistical significance [median ERT in hours-discharged vs expired: 24 (IQR 22-72) vs 48 (IQR 24-120) p=0.19]. Multivariable logistic regression analysis revealed ORT to be significantly associated with mortality [odds ratio (OR): 1.02, 95% confidence interval (CI): 1.003-1.041; p=0.02]. Adjusted Cox regression analysis showed that each hour of ORT increased the risk of mortality by 1.5% [hazard ratio (HR) 1.015, 95% CI 1.001-1.030]. Conclusion Inpatient delays increased the risk of mortality for patients undergoing emergency laparotomy for alimentary tract perforation. Larger sample sizes and prospective studies are needed to better understand this relationship and the impact pre-hospital delays have on outcomes.
住院延迟与消化道穿孔患者死亡率增加有关。在低收入和中等收入国家（LMICs），获得外科治疗是一个突出的健康问题，在这些国家，患者就诊也因多种原因而延迟，这些原因大致可分为社会/文化、经济和结构方面。这些延迟对低收入和中等收入国家手术结果的影响尚不清楚。
在巴基斯坦卡拉奇的一家三级医院，对2015年7月至2018年6月期间因消化道穿孔接受急诊剖腹手术的患者进行了一项回顾性队列研究。记录了两个时间变量：症状出现到急诊室就诊时间（ERT）和急诊室到手术室时间（ORT）。
总体而言，80名患者纳入研究。死亡的12名（15%）患者年龄显著更大（57±17.7岁），Charlson合并症指数更高，ORT更长[出院患者与死亡患者的ORT中位数（小时）：8.2（四分位间距5-15）对16（四分位间距12-28），p=0.02]。ERT也更长，但缺乏统计学意义[出院患者与死亡患者的ERT中位数（小时）：24（四分位间距22-72）对48（四分位间距24-120），p=0.19]。多变量逻辑回归分析显示ORT与死亡率显著相关[比值比（OR）：1.02，95%置信区间（CI）：1.003-1.041；p=0.02]。调整后的Cox回归分析表明，ORT每增加一小时，死亡风险增加1.5%[风险比（HR）1.015，95%CI 1.001-1.030]。
住院延迟增加了因消化道穿孔接受急诊剖腹手术患者的死亡风险。需要更大样本量和前瞻性研究来更好地理解这种关系以及院前延迟对结果的影响。
