Deresse Tilahun, Tesfahun Esubalew, Gebreegziabher Zenebe Abebe, Bogale Mandante, Alemayehu Dawit, Dessalegn Megbar, Kifleyohans Tewodros, Eskandar George
Department of Surgery, Debre Berhan University, Debre Berhan, Ethiopia.
Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia.
Open Access Emerg Med. 2023 Oct 19;15:383-392. doi: 10.2147/OAEM.S430193. eCollection 2023.
Acute sigmoid volvulus is a surgical emergency with closed-loop obstruction of the colon that often requires emergency laparotomy, which is associated with a multitude of post-operative complications. Although sigmoid volvulus is the main cause of intestinal obstruction in Ethiopia, local studies of its management outcomes are limited.
To assess the magnitude and predictors of adverse perioperative outcomes of emergency laparotomy for acute sigmoid volvulus in the Debre Markos Comprehensive Specialized Hospital (DMCSH), Amhara region, Ethiopia in 2023.
This was a retrospective follow-up study. Descriptive statistics were used to measure perioperative outcomes and other study variables. Bivariable and multivariable logistic regression models were used to identify the predictors of adverse surgical outcomes. Associations were considered significant at p < 0.05 (95% confidence interval).
In total, 170 study participants were enrolled, with a response rate of 91.4%. Forty-nine patients (28.8%) developed perioperative adverse outcomes. Pneumonia (29 patients, 28.1%), surgical site infection (19 patients, 18.4%), and wound dehiscence (10 patients, 9.7%) were the most common complications. Pre-operative shock [AOR: 3.87 (95% CI: (1.22, 12.28))], pus or fecal matter contamination of the peritoneum [AOR: 4.43 (95% CI: (1.35, 14.47)], and a higher American Society of Anesthesiologists (ASA) score [AOR: 2.37 (95% CI: (1.05, 5.34))] were identified as predictors of perioperative adverse events.
The perioperative adverse outcomes in this study were higher than those reported in Ethiopian national and global reports following emergency laparotomies. Hypotension at presentation, pus and/or fecal matter contamination of the peritoneum, and higher ASA scores are strong predictors of increased perioperative adverse outcomes. Therefore, healthcare providers and institutions involved in the delivery of emergency surgical care should emphasize the importance of early surgical intervention, adequate resuscitation, and patient monitoring to improve perioperative outcomes.
急性乙状结肠扭转是一种外科急症，伴有结肠闭袢性梗阻，常需急诊剖腹手术，这与多种术后并发症相关。尽管乙状结肠扭转是埃塞俄比亚肠梗阻的主要原因，但关于其治疗结果的本地研究有限。
评估2023年埃塞俄比亚阿姆哈拉州德布雷马科斯综合专科医院（DMCSH）急性乙状结肠扭转急诊剖腹手术围手术期不良结局的发生率及预测因素。
这是一项回顾性随访研究。采用描述性统计来衡量围手术期结局及其他研究变量。使用二元和多变量逻辑回归模型来确定手术不良结局的预测因素。p<0.05（95%置信区间）时的关联被视为具有统计学意义。
总共纳入了170名研究参与者，应答率为91.4%。49名患者（28.8%）出现围手术期不良结局。肺炎（29例，28.1%）、手术部位感染（19例，18.4%）和伤口裂开（10例，9.7%）是最常见的并发症。术前休克[AOR：3.87（95%CI：（1.22，12.28））]、腹膜脓性或粪便污染[AOR：4.43（95%CI：（1.35，14.47））]以及较高的美国麻醉医师协会（ASA）评分[AOR：2.37（95%CI：（1.05，5.34））]被确定为围手术期不良事件的预测因素。
本研究中的围手术期不良结局高于埃塞俄比亚国家报告和全球报告中急诊剖腹手术后报告的不良结局。就诊时低血压、腹膜脓性和/或粪便污染以及较高的ASA评分是围手术期不良结局增加的有力预测因素。因此，参与提供急诊外科护理的医疗服务提供者和机构应强调早期手术干预、充分复苏和患者监测对改善围手术期结局的重要性。
