B. S. Hendriksen1, L. K. Keeney1, D. J. Morrell1, X. Candela2, P. Ssentongo3, J. S. Oh1, C. S. Hollenbeak3, T. E. Arkorful4, E. K. Marfo4, F. Amponsah4 1Penn State Health Milton S. Hershey Medical Center,Hershey, PA, USA 2Penn State University College Of Medicine,Hershey, PA, USA 3The Pennsylvania State University,University Park, PA, USA 4Eastern Regional Hospital,Koforidua, EASTERN REGION, Ghana
Introduction: Exploratory laparotomy represents one of the most common operations performed at rural surgical referral centers throughout Ghana. Late disease presentation combined with a frequent lack of pre-operative imaging makes these operations challenging. In order to identify areas for future quality improvement efforts, we aimed to assess the epidemiology of exploratory laparotomy and to investigate perioperative mortality as a benchmark quality measure.
Methods: Surgical logbooks were queried at a regional referral hospital in Eastern Region, Ghana to identify cases of exploratory laparotomy from July 2017 through June 2018. The logbooks allowed for corroboration of patient data in the electronic medical record. Logistic regression was used to identify predictors of perioperative mortality.
Results:
The study included 286 adult and 60 pediatric operations. Appendicitis (29%), obstruction (26%), perforated peptic ulcer disease (15%) and major abdominal trauma (6%) were the most common diagnoses in adults. Appendicitis (40%), intussusception (17%), major abdominal trauma (10%), and typhoid ileitis (7%) were the most common in children. Males accounted for 65% of cases. Only 60 % of operations were covered by national health insurance. The overall perioperative mortality rate was 11.5% (12.6% adults; 6.7% pediatric). 60% of mortalities were referrals from outside hospitals and the mortality rate for referrals was 13.5%. Mortality had 13 times greater odds with perforated peptic ulcer disease (OR 13.1, p=0.025) and 12 times greater odds with trauma (OR 11.7, p=0.042). Female gender (OR 0.3, p=0.016) and the national health insurance (OR 0.4, p=0.031) were protective variables. Individuals 60 and older (OR 3.3, p=0.016) had higher mortality.
Conclusion:
Perforated peptic ulcer disease and major abdominal trauma carry significant risk of mortality and represent high impact areas for quality improvement. Efforts to improve national healthcare coverage and care for patients requiring surgical referral could decrease surgical mortalities.