D. J. Morrell1, B. S. Hendriksen1, L. Keeney1, X. Candela2, T. E. Arkorful4, P. Ssentongo5, R. H. Darko4, J. S. Oh1, C. S. Hollenbeak3, F. Amponsah4 1Penn State Health Milton S. Hershey Medical Center,Department Of Surgery,Hershey, PA, USA 2Penn State University College Of Medicine,Hershey, PA, USA 3The Pennsylvania State University,Department Of Health Policy And Administration,University Park, PA, USA 4Eastern Regional Hospital,Koforidua, EASTERN REGION, Ghana 5The Pennsylvania State University,University Park, PA, USA
Introduction:
Increased length of stay (LOS) and readmission represent significant economic burden on patients and families faced with surgical disease in low- and middle-income countries given limited surgical access, infrastructure, and variable insurance status. This study aims to identify risk factors of LOS and readmission in order to better direct future interventions in postoperative care in rural Ghana.
Methods:
Data for exploratory laparotomy procedures were obtained from surgical case logs collected at a regional referral hospital in Eastern Region, Ghana from July 2017 to June 2018. This information was compared with the hospital electronic medical record to collect demographic data, laboratory values, and outcomes. Multivariable analyses were used to model LOS and readmission controlling for potential confounders.
Results:
The study included 346 exploratory laparotomy procedures (286 adult, 60 pediatric) for various surgical diseases. Average age at surgery was 40 and males accounted for 65% of all procedures. 40% of patients were uninsured. Hemoglobin levels were measured on admission for 71% of patients and 44% of those patients were anemic. The major indications for surgery were appendicitis (31%), intestinal obstruction (23%), perforated peptic ulcer disease (12%), and trauma (7%). The overall LOS for adult and pediatric patients were 7.2 and 6.9 days respectively. Surgery for intestinal obstruction and major abdominal trauma resulted in increased LOS by 4.6 and 4.1 days respectively (p<0.001, p=0.031). Anemia increased LOS by 3 days (p=0.002). Rate of readmission for adults was 9.4% and 8% for pediatric patients. Patients with national health insurance had 2.7 times greater odds of being readmitted (OR=2.7, p=0.04) and those with anemia had 3.9 times greater odds of being readmitted (OR=3.9, p=0.002).
Conclusion:
Anemia represents a risk factor for both increased length of stay and readmission. Major abdominal trauma is also a risk factor for increased LOS. Future interventions aimed at preventing and treating anemia and improving trauma care may decrease some of the post-operative burden placed on patients and their families.