Effect of in-hospital delays on surgical mortality for emergency general surgery conditions at a tertiary hospital in Malawi.
Adolescent
Adult
Emergency Service, Hospital
/ standards
Female
General Surgery
/ statistics & numerical data
Hospital Mortality
/ trends
Hospitalization
/ statistics & numerical data
Humans
Intestinal Perforation
/ epidemiology
Malawi
/ epidemiology
Male
Middle Aged
Patient Acceptance of Health Care
Peritonitis
/ epidemiology
Prospective Studies
Risk Assessment
Tertiary Care Centers
Time-to-Treatment
/ statistics & numerical data
Young Adult
Journal
BJS open
ISSN: 2474-9842
Titre abrégé: BJS Open
Pays: England
ID NLM: 101722685
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
19
12
2018
accepted:
22
01
2019
entrez:
12
6
2019
pubmed:
12
6
2019
medline:
12
6
2019
Statut:
epublish
Résumé
In sub-Saharan Africa, surgical access is limited by an inadequate surgical workforce, lack of infrastructure and decreased care-seeking by patients. Delays in treatment can result from delayed presentation (pre-hospital), delays in transfer (intrafacility) or after arrival at the treating centre (in-hospital delay; IHD). This study evaluated the effect of IHD on mortality among patients undergoing emergency general surgery and identified factors associated with IHD. Utilizing Malawi's Kamuzu Central Hospital Emergency General Surgery database, data were collected prospectively from September 2013 to November 2017. Included patients had a diagnosis considered to warrant urgent or emergency intervention for surgery. Bivariable analysis and Poisson regression modelling was done to determine the effect of IHD (more than 24 h) on mortality, and identify factors associated with IHD. Of 764 included patients, 281 (36·8 per cent) had IHDs. After adjustment, IHD (relative risk (RR) 1·68, 95 per cent c.i. 1·01 to 2·78; IHDs were associated with increased mortality. Increased staffing levels and operating room availability at tertiary hospitals, especially at night, are needed.
Sections du résumé
Background
In sub-Saharan Africa, surgical access is limited by an inadequate surgical workforce, lack of infrastructure and decreased care-seeking by patients. Delays in treatment can result from delayed presentation (pre-hospital), delays in transfer (intrafacility) or after arrival at the treating centre (in-hospital delay; IHD). This study evaluated the effect of IHD on mortality among patients undergoing emergency general surgery and identified factors associated with IHD.
Methods
Utilizing Malawi's Kamuzu Central Hospital Emergency General Surgery database, data were collected prospectively from September 2013 to November 2017. Included patients had a diagnosis considered to warrant urgent or emergency intervention for surgery. Bivariable analysis and Poisson regression modelling was done to determine the effect of IHD (more than 24 h) on mortality, and identify factors associated with IHD.
Results
Of 764 included patients, 281 (36·8 per cent) had IHDs. After adjustment, IHD (relative risk (RR) 1·68, 95 per cent c.i. 1·01 to 2·78;
Conclusion
IHDs were associated with increased mortality. Increased staffing levels and operating room availability at tertiary hospitals, especially at night, are needed.
Identifiants
pubmed: 31183453
doi: 10.1002/bjs5.50152
pii: BJS550152
pmc: PMC6551403
doi:
Types de publication
Journal Article
Langues
eng
Pagination
367-375Références
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