Published in:
01-07-2020 | Acute Abdomen | Surgery in Low and Middle Income Countries
District General Hospital Surgical Capacity and Mortality Trends in Patients with Acute Abdomen in Malawi
Published in: World Journal of Surgery | Issue 7/2020
Login to get accessAbstract
Background
The burden of emergency general surgery conditions is high in sub-Saharan Africa, and poor access to surgical care leads to poor patient outcomes. We examined the trends in mortality in patients presenting with an acute abdomen to a referral hospital.
Methods
A retrospective analysis of the prospectively collected Kamuzu Central Hospital Acute Care Surgery database was performed (January 2014 to July 2019). Bivariate analysis was conducted by year of admission. A multivariate Poisson regression was performed to identify predictors of mortality.
Results
During the study, 2509 patients with acute abdomen presented. The majority of patients presenting were transferred from outside hospitals (n = 2097, 83.9%). Mortality was highest in patients with preoperative diagnosis of peritonitis (n = 119, 22.2%), bowel obstruction (n = 214, 18.7%), and volvuli (n = 51, 18.6%). There was no difference in mortality by year, p = 0.1. On multivariate Poisson regression, there was an increased relative risk of mortality with being transferred (RR 1.31, 95% CI 1.12–1.55, p = 0.002), as well as undergoing an operation within 1–2 days (RR 1.48, 95% CI 1.16–1.87, p < 0.001) and >2 days (RR 1.46, 95% CI 1.17–1.82, p = 0.001) after presentation.
Conclusion
The majority of patients in our study who presented with an acute abdomen were transferred from district hospitals, which resulted in high mortality due to delays in surgical care. Therefore, the WHO’s recommendation that the majority of district hospitals perform the Bellwether procedures does not occur in district hospitals in central Malawi. District hospitals require significant resource investment to reduce transfers needs and patient mortality.