Key result
Preoperative waits >6 hours linked to ~170% higher in-hospital complication risk after emergency abdominal surgery.
Why the study?
In-hospital waiting time reflecting perioperative promptness for non-traumatic emergency abdominal surgeries remains largely unexplored in developing countries, despite its critical role in determining treatment outcomes.
Cross-Sectional (n=111)
No
Odds Ratio: 2.7 (95% CI 1–7.2)
p-value: p=<0.05
Prolonged preoperative waiting times for emergency abdominal surgeries are common in this setting and are significantly associated with increased in-hospital complications.
Prolonged preoperative delays were associated with complications; hypothesis-generating for efficiency interventions in comparable low-resource settings.
Non-traumatic emergency abdominal surgeries are common in most settings. To a significant extent, the outcomes of treatment are determined by the promptness of surgical interventions. However, the in-hospital waiting time which reflects perioperative promptness remains largely unexplored in developing countries. To describe the preoperative waiting time, identify the causes of delays, and determine subsequent outcomes for non-traumatic emergency abdominal surgeries. A cross-sectional study was conducted at a consultant zonal hospital in northern Tanzania from September 2012 to March 2013. Patients admitted and surgically treated for non-traumatic acute abdominal conditions were consecutively sampled. Sociodemographic and clinical data were obtained from medical records. Delays in surgical interventions were assessed based on observations at the Emergency Department and record analysis. Descriptive statistics and regression analysis were used to summarize the data and assess for factors influencing post-operative outcomes, respectively. The study included 111 participants with a median age of 29 years (IQR=18-53). The median in-hospital preoperative waiting was 10.5 hours (IQR=6.6-14.7), with a substantial majority (78.4%) experiencing delays beyond 6 hours. The frequent reasons for delayed surgery included personnel-related factors (37.8%), unavailable theater space (31.5%), and investigation-related factors (28.8%). Delayed hospital presentation (symptoms ≥24 hours) (OR=3.9, 95% CI=1.0-14.9) and prolonged waiting time (>6 hours) (OR=2.7, 95% CI=1.0-7.2) were significantly associated (P<0.05) with in-hospital complications that included wound dehiscence (0.9%), re-operation (3.6%), surgical site infection (18.0%), and complications necessitating Intensive Care Unit admission (36.9%). The in-hospital operative mortality rate was 18.0%. Age of ≤40 years (OR=0.1, 95% CI=0.04-0.4) and ASA-PS class I-II (OR=0.1, 95% CI=0.0-0.3) were identified as significant (P<0.001) protective factors against operative mortality. These benchmark findings highlight the multifactorial nature of the reasons for delayed surgical interventions and its association with postoperative complications; offering a potential avenue to enhance surgical efficiency in the index and comparable settings.
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Mchele et al. (2023) conducted a cross-sectional in Non-traumatic acute abdominal conditions (n=111). Prolonged preoperative waiting time (>6 hours) vs. Waiting time ≤6 hours was evaluated on In-hospital complications (OR 2.7, 95% CI 1.0-7.2, p=<0.05). Prolonged preoperative waiting time (>6 hours) was significantly associated with in-hospital complications (OR 2.7; 95% CI 1.0-7.2; P<0.05) following non-traumatic emergency abdominal surgeries.
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