Intraoperative findings and predictors for length of hospital stay among elderly patients undergoing emergency exploratory laparotomy: a multi-centre prospective study

BACKGROUND: Geriatric patients commonly pose a significant challenge, mainly in emergency settings where the time to optimize the high-risk patient with other associated co-morbidities is inadequate, which predisposes these patients to a number of adverse outcomes postoperatively. There is paucity of data on intraoperative findings and predictors for length of hospital stay among elderly surgical patients in Uganda. This study assessed the intraoperative findings and predictors for length of hospital stay among elderly patients undergoing emergency exploratory laparotomy at Jinja, Lira, Hoima, and Fort Portal Regional Referral Hospitals in eastern, northern and western Uganda, respectively. METHODS: This was a prospective observational cohort in which elderly patients (≥ 65 years) that underwent emergency exploratory laparotomy were enrolled and followed up until time of discharge to assess for the number of days spent in hospital. The intraoperative findings were documented during surgery per study participant. SPSS version 26 was used for analysis, with modified Poisson regression done to determine the significant predictors. P < 0.05 was considered significant. RESULTS: Of the 86 participants, 29.1% were above 80 years of age. Majority were male (74.4%). The most common diagnosis was intestinal obstruction (55.8%) followed by gut perforation (30.2%). Of the 77 that survived, prolonged hospital stay was seen in 35.1%. The median length of hospital stay was 7 days, while the mean was 8.57 days. In the multivariable analysis, American association of anesthesiology class III and having a perforation were associated with prolonged hospital stay (P < 0.05 for all). CONCLUSION: Over one third of the study participants had a prolonged hospital stay. Optimization of patients should focus on improving the American association of anesthesiology score, in order to create chances of early discharge and reduce cases of prolonged hospital stays.