Perioperative outcomes and its determinants among patients operated for emergency laparotomy in Southern Ethiopia, 2023: a prospective multi-center cohort study

Abstract

Background: Worldwide, emergency laparotomy is frequently performed surgery. It is a resource-intensive surgical procedure with high morbidity and mortality rates even in the best healthcare systems. Poor postoperative outcomes predispose patients to prolonged recovery, increased length of stay, and worsened clinical status. However, pieces of evidence are scarce in our country regarding postoperative outcomes of emergency laparotomy. Objective: The general objective of the study was to investigate the perioperative clinical outcomes and its determinants among patients who operated for emergency laparotomy in Southern Ethiopia from 10 March 2022, to 15 April 2023. Method: After obtaining Ethical clearance from the Research Ethics and Review Board (RERB), a multi-center cohort study was conducted in Southern Ethiopia from 10 March 2022, to 15 April 2023. Three hundred sixty-six consecutive patients undergoing emergency laparotomy were followed to assess perioperative clinical outcomes and their determinants. Continuous data were presented as mean, median, and standard deviation (SD) and the categorical data were presented as the percentage in each category. Data were analyzed using SPSS version 26. Multivariable logistic regression analysis was conducted. The significant level of prediction was considered with a P value less than 0.05, and an adjusted odds ratio (AOR) was calculated at a 95% CI. Result: The cumulative incidence of perioperative mortality was 31%. Diabetes mellitus (AOR=10.1, 95% CI: 2.78, 36.57), small bowel obstruction (AOR=6.4, 95% CI: 2.69, 15.13), aspiration (OR=5.5, 95% CI: 1.44, 21.26), and ASA IV (AOR=4.6, 95% CI: 1.48, 14.35) were independent predictors of mortality. Conclusion: This study revealed that there is a significant level of perioperative mortality, which necessitates preoperative optimization, risk assessment, and standardization of effective perioperative care following an emergency.