Emergency general surgery in a low-middle income health care setting: Determinants of outcomes

Authors

Adil Aijaz Shah, Aga Khan UniversityFollow
Asad Latif, Johns Hopkins University School of Medicine, United StatesFollow
Cheryl K. Zogg, Harvard Medical School and Harvard School of Public Health, Johns Hopkins University School of Medicine, United States
Syed Nabeel Zafar, Aga Khan University Hospital
Robert Riviello, Howard University College of Medicine, United States
Muhammad Sohail Halim, Aga Khan University
Zia Ur Rehman, Aga Khan UniversityFollow
Adil H. Haider, Harvard Medical School and Harvard School of Public Health, United StatesFollow
Hasnain Zafar, Aga Khan UniversityFollow

Document Type

Article

Department

Anaesthesia; Surgery; Cardiothoracic Surgery; General Surgery

Abstract

Introduction: Emergency general surgery (EGS) has emerged as an important component of frontline operative care. Efforts in high-income settings have described its burden but have yet to consider low- and middle-income health care settings in which emergent conditions represent a high proportion of operative need. The objective of this study was to describe the disease spectrum of EGS conditions and associated factors among patients presenting in a low-middle income context.
Methods: March 2009-April 2014 discharge data from a university teaching hospital in South Asia were obtained for patients (≥16 years) with primary International Classification of Diseases, 9(th) revision, Clinical Modification diagnosis codes consistent with an EGS condition as defined by the American Association for the Surgery of Trauma. Outcomes included in-hospital mortality and occurrence of ≥1 major complication(s). Multivariable analyses were performed, adjusting for differences in demographic and case-mix factors.
Results: A total of 13,893 discharge records corresponded to EGS conditions. Average age was 47.2 years (±16.8, standard deviation), with a male preponderance (59.9%). The majority presented with admitting diagnoses of biliary disease (20.2%), followed by soft-tissue disorders (15.7%), hernias (14.9%), and colorectal disease (14.3%). Rates of death and complications were 2.7% and 6.6%, respectively; increasing age was an independent predictor of both. Patients in need of resuscitation (n = 225) had the greatest rates of mortality (72.9%) and complications (94.2%).
Conclusion: This study takes an important step toward quantifying outcomes and complications of EGS, providing one of the first assessments of EGS conditions using American Association for the Surgery of Trauma definitions in a low-middle income health care setting. Further efforts in varied settings are needed to promote representative benchmarking worldwide

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

Surgery

Recommended Citation

Shah, A., Latif, A., Zogg, C. K., Nabeel Zafar, S., Riviello, R., Halim, M., Rehman, Z., Haider, A. H., Zafar, H. (2016). Emergency general surgery in a low-middle income health care setting: Determinants of outcomes. Surgery, 159(2), 641-649.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_surg/609