Determinants of preoperative care timelines in emergency abdominal surgery in Tanzania

Background Emergency abdominal surgical conditions are common and require timely intervention to reduce the morbidity and mortality associated with delays. However, the magnitude, timing, and determinants of preoperative care delays remain underexplored in Sub-Saharan Africa. Objective To describe preoperative care timelines and identify factors associated with delays in the management of emergency abdominal surgical conditions. Methods A cross-sectional study was conducted at Muhimbili National Hospital, Dar es Salaam, Tanzania, including consecutively sampled adult patients who underwent emergency abdominal surgery between 1st January and 31st December 2024. Preoperative timelines were categorised into three intervals: T1 (symptom onset to hospital arrival), T2 (hospital arrival to surgical decision), and T3 (surgical decision to the initiation of surgery). Sociodemographic and clinical characteristics were evaluated as determinants of the preoperative interval duration using median (τ = 0.5) quantile regression analysis. Results The median T1 was 48.0 h (IQR: 12.0–96.0), T2 was 5.0 h (IQR: 3.0–6.0), and T3 was 2.0 h (IQR: 1.0–3.0). Shorter T1 was observed among patients with no formal education (aβ=−34.0 h; 95% CI: −59.8 to −8.3) and those with secondary education (aβ=−34.0 h; 95% CI: −66.3 to −1.7). Longer T1 was associated with out-of-pocket payment (aβ=+28.0 h; 95% CI: 5.0–51.0) and non-traumatic conditions (aβ=+40.0 h; 95% CI: 12.6–67.5). Prolonged T2+T3 was associated with bowel obstruction cases (aExp[β]=1.27; 95% CI:1.17–1.39), while hypothermia (aExp[β]=0.94; 95% CI: 0.88–0.99) and moderate anemia (aExp[β]=0.84; 95% CI: 0.72–0.98) were associated with shorter in-hospital timelines. Conclusion Substantial pre-hospital delays persist, especially among patients with non-traumatic conditions and among the uninsured. Strengthening emergency capacity, decentralizing essential surgical services to lower-level facilities, expanding universal health insurance coverage, and leveraging established trauma care pathways for nontraumatic emergencies may mitigate these delays.