Surgery

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Prospective evaluation of factors affecting post thyroidectomy outcome at three teaching hospitals from october1,2019-april30,2020,in Addis Ababa, Ethiopia.
(Addis Abeba University, 2019-10) Hayato, Telile; Dr.Seife, Henok(MD,Surgeon,Assistant Prof, of Hepatobiliery Surgoen)
Background: Postoperative complications after thyroidectomy are problematic for patients and surgeons. The postoperative outcome of thyroidectomies is related to risk factors concerning the patient, the thyroid disease and the surgeon. Thyroidectomy complications may be divided into transient or permanent. The transient may vary from severe, life threatening ones, all the way to mild and meaningless events. Permanent complications, which prevalence is variable, represent the main concern of those who treat thyroid diseases surgically. Despite its importance, the risk factors associated with post-thyroidectomy complications are not enough analyzed. Objectives: To evaluate factor affecting post thyroidectomy outcome in three teaching Hospitals in Addis Ababa Ethiopia. Method: A prospective study was conducted in surgical department of Black Lion, Yekatit and Zewuditu Memorial Hospital. The study has included patients diagnosed for thyroid swelling and operated from October 1 2019 –April 30, 2020, meeting the following criteria: MNG; operation by surgeons with various experiences; and minimum follow-up of 1 month. Age, thyroid function test, indication for surgery, types of surgery, surgeon experience, intraoperative adhesion and estimated blood loss were analyzed as risk factors for post thyroidectomy outcome. Data was analyzed using SPSS version 20.0. P values < 0.05 were considered statistically Significant. Result: During the study period 120 thyroidectomies were performed. There were 20 (16.66%)males and 100 females (83.33%)with Male to female ratio was 1:5.Total Thyroidectomy+,LND performed in 4(3.3%) and Total thyroidectomy alone was performed in 10(8.3.%) patients. Total complications occurred was 23 (19.16%) in 120 patients. Wound infection was the most complication seen in 7(5.8%)of patients and hematoma was seen in 6(5%)patients. 3(2.5%)of patients suffered from recurrent laryngeal nerve palsy and hypocalcemia. There was association b/n early postoperative complication with age (p value=.025 b ), Indication for Surgery (p value.031 b, )and type of surgery (p value.045 ). Estimated Blood Loss was significantly associated with hematoma (p value.000 b b ). Early postoperative complication also has significantly associated with thyroid function test (p value.005 b ), adhesion (p value.035b) and operating surgeon (p value .022b). no association b/n early postoperative complication with, size and duration of goiter There was no postoperative mortality in this study. Conclusion The factors affecting post thyroidectomy outcome were indication for surgery, estimated blood loss, type of surgery, thyroid function test, adhesion and surgeon experience. Patient with these factors should be advised for possible higher rate of complications and the surgeon should be prepared beforehand. Recommendation: Patients with thyroid malignancy, with considerable intraoperative bleeding needs careful hemostasis, can rebleed and develope hematoma. Further study is necessary to identify the cause of wound site infection as commonest complication observed was sugical site infection.
30 day’ Post-operative complicationsof Intracranial Meningioma Surgery
(Addis Abeba University, 2020-01) Sileshi, Dagmawi; Kasahun, Azarias( MD, FCS (ECSA), Assistant professor)
Background: Meningioma is the most common primary intracranial tumor. Even though different management options exist in modern medicine, surgery is still the only cure for this benign tumor. Surgical options are not without risk. Identifying and predicting the short-term complications in an Ethiopian setup might be useful in the decision-making process before surgery for our patients. This study uses a prospective design that aims to assess 30 days of posoperative complications of intracranial meningioma. Methods: Aprospective study that was conducted at TASH, ZMH & MCM hospital between November 1, 2019, and September 1, 2020. Assessment of postoperative complications was determined in-person using a standard questionnaire in both inpatient & outpatient setup. For the investigation, pathology & Intraoperative findings data were collected from medical charts, radiology, and pathology archives.Data were checked for completeness and quality control aftewhich, it was entered on SPSS version 21 for analysis using logistic regression. Results:A total of 77 patients were enrolled in the study. The mean age of the patients was 40.94 years. 71 (92%) patients presented with headache and 62 (80.5%) patients had one or more focal neurologic deficits. Tumor was classified based on location and size. 47 (61%) of the tumors were skull base tumors.The surgical mortality rate which was defined as death within one month was 9.1%. Among all patients, 37 (48.1%)had one or more postoperative complications of which new-onset or worsened focal deficit was the commonest. A significant association was seen between skull base tumors and postoperative complications in both bivariate and multivariate analyses witha p-value of 0.01 (OR=5.79, 95% CI: 2.061-16.312. Conclusion: Even though the complications and mortality rates were high, surgery led to symptom improvement in a large proportion of patients. Skull base meningioma, anesthesia time more than 5 hours, and blood loss more than 1000ml hada significant association with postoperative complications.
Pattern of Major Maxillofacial Surgeries at Addis Ababa University Tikur Anbessa Specialized Hospital Oral & Maxillofacial Surgery Affiliate Hospitals: 3 Years Retrospective Analysis.
(Addis Abeba University, 2020-08) Adula, Surafel; Dana, Demerew Dejene (Assistant Professor of oral& maxillofacial surgery)
Background: Oral and maxillofacial (OMF) region is an area that is prone to multitude of disease conditions which may be of developmental nature or acquired nature which require surgical intervention in many occasions. Objectives: To describe the indications, pattern and types of major oral and maxillofacial surgical procedures carried out at Addis Ababa university Oral & Maxillofacial Surgery (OMFS) affiliate Hospitals (Yekatit 12 Hospital Medical College and St.Peters Specialized Hospital) in a period of 3 years from January 2017 to December2019. Methods: A retrospective study of operation records of all patients who had undergone oral and maxillofacial surgeries under general anaesthesia at Yekatit 12 Hospital Medical College and St.Peters Specialized Hospital in a period of 3 years from January 2017 to December 2019 was done. Descriptive statistics such as biodata, indication for surgery and type of surgery were recorded and analyzed using the Epi info version 7 software. Time frame: The study was conducted from November 2019 to August 2020. Result: A total of 689 patients with oral and maxillofacial conditions were managed during the study period. The male to female ratio was 2.48:1, and the mean age of patients was 29.05 years with standard deviation of ±15.5.The predominant indications for surgery were traumatic conditions (50.71%, n=354), followed by neoplastic(benign and malignant)conditions (18.7%, n=129), and tumorlike /cystic conditions (16.5%, n=115). Open reduction and internal fixation the most common (43.7%,n=313) surgical procedure performed under general anaesthesia. Conclusion: The field of Oral and Maxillofacial surgery in our climes is a relatively new one, however, it is evolving and its relevance is growing. With the observed relatively high frequency of traumatic conditions, especially among younger populations, efforts geared at prevention and adequate preparedness for proper surgical management of such patients should be commenced.
Incidence and pattern of mandible fractures in AAU affiliated hospitals (Yekatit 12 Hosptial Medical College and St.Peter’s specialized Hospital) Addis Ababa, Ethiopia.
(Addis Abeba University, 2020-08) Abera, Assefa; Dr.Dejene, Demerew (Assistant Professor of Oral and Maxillofacial Surgery); Dr.Uma, Girma (Assistant Professor of Oral and Maxillofacial Surgery)
Objectives: The objective of this study was to assess the incidence and pattern of mandible fractures in AAU affiliated hospitals in Addis Ababa, Ethiopia over a retrospective period of 3 years from January 2017 to December 2019 G C. Methodology: Retrospective review of pat ient’s records was conducted among those patients who visited AAU affiliated hospitals having mandibular fractures. The study was conducted from November, 2019 to August, 2020. The patients chart with incomplete information and those which are absent from shelf were excluded from the study. The data was entered, cleaned and analyzed using Epi info data version 7.0 Software. Descriptive analysis was computed as frequency of fractures, distribution of age, gender, etiology, diagnosis, and anatomical sites of mandibular fractures. Results: A total of 247 patients who were retrospectively evaluated at Yekatit 12 HMC and St.Peter’s specialized hospital between January 2017 and December 2019 sustained 343 mandibular fractures (mean of 1.4, range 1-3). The incidence of mandibular fracture was higher in male patients (83%) than in females (17%) (Male: Female ratio 5:1), and the peak incidence was during the third decade for both genders. The most common site of fracture was the body (26.53%), followed by the angle (23.9%), and parasymphysis (19.82%). Overall, interpersonal violence (46.15%) was the most common cause followed by RTA (27.53%). In male patients, the most common cause was interpersonal violence (50%); in females it was a RTA (34.14%). The anatomical sites of fracture reflected their cause. A total of (n=76, 30.76%) patients sustained other non-maxillofacial injuries of which head injury (n=58, 23.48%) is the most common. Conclusions: The most common cause of mandibular fracture was interpersonal violence. Mandibular fractures were more common in males than females with most patients aged 21-30 years. The most common fracture site was body of the mandible. The predominant treatment modality was open reduction and internal fixation (ORIF).
Mini-cholecystectomy: A 5-year retrospective cross-sectional study
(Addis Abeba University, 2020-10) Bekele, Solomon; Prof.Ersumo, Tessema( Ass. Professor of Surgery, CHS, AAUandProfessor of Surgery); Tamirat, Girmaye(MD, Consultant General and EndocrineSurgeon)
Background: Gallstone disease is one of the most common surgical pathology. cholecystectomy is main mode of management for gallstones. Laparoscopic cholecystectomy, open cholecystectomy, and mini cholecystectomy are options for surgical removal of the gallbladder.Several studies showed that minicholecystectomy offers minimal trauma to the patient with similar complication rate. Objectives: This study is aimed to determine and analyze the outcomes of Mini-Cholecystectomy performed at Betezatha General Hospital from January 1, 2014 to December 31, 2019. Patients and Methods: A 5-Year retrospective cross-sectional study ofall patients who underwent mini-cholecystectomies from January 1, 2014 through December 31, 2019 at Betezatha General Hospital. Results: A total of 206 patients underwent mini-cholecystectomy. With a male to female ratio of 1:6. Most patients (57%) presented with RUQ pain. Almost 70% of patients were found to have at least one comorbidity along with gallstone disease. The average operation time was 35minutes. Patients with chronic contracted cholecystitis were found to have difficult minicholecystectomy. Conversion rate to standard cholecystectomy was 2.9%. Bile duct injury occurred in 1 patient (0.45%). Almost all patients (98%) had hospital stay of less than 72hrs. Conclusions: Mini-cholecystectomy is a safe method of cholecystectomy which can be practiced in a resource limited setting without undue complications.
Clinical Outcomes and Prognostic Determinants of Surgically Treated Depressed Skull Fracture in Addis Ababa University Neurosurgical Teaching Hospitals: A Prospective Multicenter Observational Study
(Addis Abeba University, 2020-10) Hussein, Abdulaziz Abdellah; Laeke, Tsegazeab ( MD, FCS (ECSA) 2
Background: Depressed skull fracture (DSF) is one of the commonest neurosurgical emergencies in Ethiopia. The clinical outcome after surgical management and what factors predict the outcome is not well-studied, especially in low-income countries like Ethiopia. Our study aimed to assess the clinical outcomes of DSF and identify predictors of the outcome in surgically treated adult patients. Methodology: A prospective, multicenter, observational study was undertaken on 197 surgically treated patients with DSF from June 1, 2018, to June 30, 2020, at four selected neurosurgical teaching hospitals in Ethiopia. Adult patients with clinically palpable or CT evidence of DSF who underwent surgery for the primary indication of the DSF were included in this study. Data on patients‟ socio-demographics, mechanisms of injury, clinical findings at presentation, imaging, and intraoperative findings, and postoperative course was collected and analyzed. The outcome was assessed by the extended Glasgow outcome scale (GOS-E): as favorable or unfavorable. Bivariate analysis was done to identify factors that correlate with the clinical outcome and multivariate logistic regression analysis was done to identify independent predictors of the outcome. Results: The overall clinical outcome was favorable in 81.2% of 197 patients. The mean age of participants was 27.77 +/- 10.21 years with a male to female ratio of 23.6:1. The most common mode of injury was violence-related 157 (79.7%). The DSF was compound in 186 (94.4%). Posttraumatic motor deficit and early posttraumatic seizures were witnessed in 24.4% and 8.1% respectively. Based on post-resuscitation GCS 182(92.2%) patients had mild TBI, 12(6.1%) moderate TBI, and only 3(1.5%) were in severe TBI. The most common site of fracture was frontal bone involved in 103 (52.3%) of cases, followed by parietal bone in 48 (24.4%). Associated intracranial lesion was identified in 172 (87.3%) of cases. The median days of hospital stay were 4.7 days. Totally 8(4.1%) patients underwent reoperation and the overall mortality was 0.5%. In bivariate and multivariate analysis, posttraumatic motor deficit (adjusted OR 13.8, 95% CI: 4.13-46.17, P=0.000), post-resuscitation GCS ≤13 (adjusted OR 10.36, 95% CI: 1.93-55.56, P=0.006), pneumocephalus on brain CT scan (adjusted OR 12.93, 95% CI: 3.1253.52, P=0.000), hospital stay for ≥ 3 days (adjusted OR 4.39, 95% CI: 1.18-16.3, P=0.027) and reoperation (adjusted OR 6.92, 95% CI: 1.091- 43.97, P=0.04) were statistically significant independent predictors of unfavorable outcome. Conclusion: The overall outcome of surgical treatment for DSF in this study was favorable. The presence of motor deficit, post-resuscitation GCS ≤ 13, pneumocephalus, reoperation, and hospital stays for ≥ 3 days were independent predictors of an unfavorable outcome.
Assessment of adequacy of surgical resection for colorectal cancer at Tikur Anbessa specialized hospital from2016-2019, Addis Ababa, Ethiopia.
(Addis Abeba University, 2020-10) Nibret, Yonas; Seyoum, Nebyou(MD, Associate Prof. of Surgery); Kotisso, Berhanu(MD, Prof. of Surgery)
Background: Colorectal carcinoma is a malignant neoplasm of the colon and rectum. It is the most common malignancy of the gastrointestinal tract. The enbloc removal of the presenting malignancy, to include adequate margins plus the lymphatic nodal basin, remains the hallmark of surgical treatment for cure. Adequate lymph node evaluation is required for proper staging of colorectal cancer, and the number of lymph nodes examined is associated with survival Objectives: To determine the adequacy of surgical resection of patients operated for colorectal cancer at Tikur Anbessa Specialized Hospital. Methods: A retrospective cross-sectional study was conducted by a review of the medical records of all patients who had undergone resection of colorectal cancer at Tikur Anbessa Specialized hospital from January 1, 2016 to December 31, 2019. The data was obtained from the patient’s record review; data was collected using a pretested questionnaire and checklist. Data were checked and entered into Epi data version 3.1 then exported to statically package for social science version 24 for analysis. Result: From the total of study participants above the half 48(53.3%) are male, with male to female ratio of 1.14:1. The majority 44(48.9%) of study participants were found in the age groups of <50 years followed by 50-64 years 26(28.9%).The mean of LN harvested was 10.35(SD ±7.86) with a maximum of 41 and a minimum of 0.And only40% of patients had Adequate LN harvested (≥12). female patients were 2.12 times more likely to have adequate LN harvested as compared to male patients with AOR=2.12(1.49-3.96). Similarly, patients found in the age group of ≥65 were less likely to have adequate LN harvested as compared to patients found in the age group of <50 years with AOR=1.22 (1.60-4.88). Those patients with an age group of ≥65 years were 2.04 times more likely to have radial Margin involvement as compared to others, while fixed tumors are 2.81 times more likely to have radial margin involvement relative to mobile tumors. Conclusion: In this retrospective study, we described the adequacy of nodal harvest in colorectal cancer and evaluated possible factors that may affect the adequacy nodal harvest. Only 40 % of the patients in this study have adequate nodal harvest based on current guidelines. Younger patients less than 50 years of age and female patients were associated with improved nodal harvest. In this study, age≥65 years and fixed tumors are more likely to have radial margin involvement.
Surgical outcome of pleuro-pulmonary Tuberculosis complications:A five year retrospective study,Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
(Addis Abeba University, 2020-10) Amare, Hiwot Yeshitila; Tamire, Ayalew Tizazu(MD ,Associate professor of Cardiothoracic Surgery, AAU )
Background Tuberculosis is one of the top ten causes of mortality in the world. It is more concerning for African countries as most of the young productive age group is the target of the disease. In the older days surgery was the main mode of management for pulmonary tuberculosis. Since the invention of anti-tuberculosis chemotherapy the role of surgery has reduced. But due to the emergence of drug resistant TB and post TB complications, surgical management is growing again. The current indications of surgery for pulmonary tuberculosis are post TB squelae and drug resistant Tuberculosis. The commonest post TB complications demanding surgery are Empyema, hemoptysis, destroyed lung, bronchiectasis, fistulas, and tuberculoma. After all medical evolutions, surgical management of TB is still one of the challenges for thoracic surgeons. Here we will see the trends of surgical interventions and outcome in terms of post-operative complication in our hospitals. Methods – It is a retrospective cross sectional case study done in Ethiopia, Addis Ababa University, college of health science, School of Medicine Tikur Anbessa Hospital, Department of surgery, cardiothoracic and vascular surgery unit on patients who underwent surgery for pathologies secondary to pulmonary Tuberculosis from January1, 2015-December31, 2019. Result – 88 patients were participants of the study. There were 59 men and 29 women. Mean age is 33.5, Maximum 65 years and Minimum 16 years with the range of 21-45. More than 90% of the patients had productive cough and 53.4% had hemoptysis. Eight patients had history of comorbidity. Only two patients were smokers. All patients had chest X-ray and 97.7% had CT scan of the chest. Out of the 88 patients 56 of them had pathology on the left side. 13.4% of patients had anemia up on presentation. Albumin level was measured in 43.1% of the patients. Out of these patients 73.6% had normal albumin level, 13.1% had mild hypoalbuminemia 10.5% moderate hypoalbuminemia, and 2.5% had severe hypoalbuminemia. Only 20% of the patients were screened for HIV infection. The mean operation time was-186 min/ (minimum 40 min, Maximum 440min). Mean total Hospital Stay was 27 days (minimum 7days, Maximum 86 days). For 57% of the patients Post op hospital stay was <14 days and 42% had stayed >14 days. The most common indication for surgery was empyema followed by Aspergilloma. The most common procedure performed is decortication followed by pneumenectomy and wedge resection. We observed a complication rate of 20% with mortality rate of 1.1%. The most common complication detected was atelectasis followed by BPF and pneumonia. Conclusion- In general Outcome of surgical management for pulmonary tuberculosis is good with relatively low morbidity and mortality. We recommend offering patients surgery on the appropriate time when having proper indication.
A retrospective cohort study on the surgical treatment outcome of patients operated for Parasagittal/falcine Meningioma at Tikur Anbessa Specialized Hospital and Myungsung Christian Medical Center from August 1, 2015 to July 31, 2019
(Addis Abeba University, 2020-10) Yibalih, Samson; Sahlu, Abat(MD Assistant Professor of Neurosurgery Head of Neurosurgery Unit )
Background: The surgical management of parasagittal and falcine meningiomas is challenging due to their proximity to the superior sagittal sinus and cortical draining veins. This nature of the tumors poses several hazards of complication related to surgery. There is a limitation of analyzed and published data on this topic in low-income countries with limited-resource settings. Objective: This study aims to assess the surgical treatment outcome of parasagittal and Falcine meningiomas at TASH and MCM, Addis Ababa, Ethiopia. Methods: This is a hospital-based retrospective cohort study of surgically treated Parasagittal and Falcine meningioma patients from August 1, 2015, to July 31, 2019. Data was collected using a well-designed questionnaire, encoded, and analyzed in SPSS version 26. Pearson’s chisquare and bivariate analysis were done to identify strongly associated factors with the complications and functional outcome of patients. Result: A total of 61 patients were operated of which 36(59%) were females. The mean age was 46.1(20 to 78) years. The mean duration of preoperative symptoms was 16.38 (1 to 60) months. Common preoperative clinical findings were headache in 47(77%) patients, motor weakness in 33(54%) patients, seizure in 26(42.6%), and Visual deficit in 17(27.9%) patients. Mean tumor size was 5.9(3.5 to 8) cms. Complete resection (SG I or II) was done in 47(77%) patients and macroscopic GTR(SG I, II, or III) was done in 54(88.5%) patients. Meningothelial was the commonest histologic type in 29(49.2%) and most tumors were WHO G1 in 47(79.9%) patients. There were 46 perioperative complications in 17(27.9%) patients. At the end of follow up 53(86.9%) patients were alive and most (45, 84.9%) of the surviving patients had substantial improvement in functional performance status. Conclusion: This study showed most of the surviving patients had significant improvement in their functional performance status which was positively related to the degree of tumor resection and a better preoperative functional status of the patients. There is a high rate of perioperative complications and this is strongly related to a longer duration of preoperative symptoms before their first surgery and the intraoperative incidents.
Treatment outcome of endoscopic third ventriculostomy in obstructive hydrocephalus patients at Tikur Anbessa Specialized Hospital, and Myung sung Christian Medical Center from January 1 2016 to June 30 2020 G.C
(Addis Abeba University, 2020-11) Sileshy, Addu; Sahlu, Abat (MD, PGD, Assistant professor of Neurosurgery)
Objective: To analyse the overall outcome of ETV in obstructive hydrocephalus in relation to neurosurgery experiences on patient selection, intraoperative incidents, post-operative complications and follow up results. Predictors for post op complications, factors responsible for successful outcome and validation of ETVSS for adult patients were also taken into account. Methodology: Institution based cross sectional retrospective study was conducted among 68 patients for whom ETV has been done at Tikur Anbessa Specialised Hospital and MCM hospital from January 1 2016 to June 30 2020 G.C. Data obtained for analysis included patient demographics, clinical manifestations, underlying etiology, ETVSS, peri operative incidents and follow up results. Collected data from patients’ medical chart using data collection checklist was checked for completeness, coded and entered to SPSS version 25 for analysis. Descriptive statistics and Binary Logistic Regression were used for data analysis. Results: Mean age at the time of procedure was 29.4yrs (Range from 2years to 68 years, SD=17.8). of which, patients aged ≥ 15 years constituted 76.5% of study population. Brain tumours (67.9%), Aqueductal Stenosis (14.7%), and PIH (11.8%) were causes of hydrocephalus in most study participants. Intraoperative uncontrolled haemorrhage (13.2%) and distorted 3rd ventricular floor anatomy (7.3%) has led to insertion of EVDs in 19.1% that subsequently led to ventriculitis in 11.8% (61.5% of all EVDs). Other encountered post op complications are IVH (14.7%), ICH (4.4%) and CSF leak (4.4%) with overall morbidity of 22%. With a mean follow up of 7.45 months, the total number of patients with shunt free survival up to their last follow up month becomes 59 with overall successful outcome of 86.7%. The mean duration of ETV failures were found to be on 20th post-operative day (range 5 to 52 days). Younger age (31.2%, PIH (50%), uncontrolled bleeding (44.4%), distorted ventricular anatomy (60%), EVD insertion (53.8%), ventriculitis (75%) and post op IVH (40%) were associated with failed outcome. Among the 68.7% of patients with a high probability of ETVSS 93.6% had a successful outcome. Conclusions: Endoscopic third ventriculostomy is a safer and more effective treatment option for obstructive hydrocephalus. Factors indicating potential poor ETV outcome are distorted ventricular anatomy, post op IVH and ventriculitis
Intraspinal Tumors: analysis of 155 surgically treated cases in three hospitals, Addis Ababa, Ethiopia.
(Addis Abeba University, 2020-11) Mohammed, Salahadin Bedru; Bogale, Thomas (M.D,Assistant professor of Neurosurgery)
Background: intraspinal tumors are one of the rare tumors of the CNS. The occurrence and distribution of intraspinal tumors by sex, age, and pathology are different among races andregions. There is a paucity of information on operated cases of spinal tumors in patients in sub-Saharan Africa Objective: Theobjective of this study is to evaluate the demographics, histologic pattern, anatomic distribution, and extent and outcome of surgery of Ethiopian patients with spinal tumors. Methodology: A retrospective study comprising a cohort of patients who underwent surgery for spinal tumors in three teaching institutions in Addis Ababa, Ethiopia, from January 1,2015, to June 30 th , 2020. Data obtained included patient demographics, duration of symptoms, anatomic location, imaging findings, McCormick scale before and after surgery, and type and outcome of the surgery. The data was collected from the patient’s medical chart using a data collection checklist and was encoded into IBM/SPSS version 25. Descriptive statistics and Binary and multivariate Logistic Regression analysis was made to identify predictors of outcome. P<0.05 was considered significant Result:A total of 155 patients were included. The mean age was 39.5 years. The mean duration of illness was 13.9 months. 75.4% had lower limb weakness. Thoracic tumors predominate 46.9% followed by cervical tumors 20.6%. The majority of the tumors were IDEM 51.6%. GTR was achieved in 67%. The most common histological origin was meningioma 35.9%. An overall complication rate of 16.8% was observed, the commonest being new/worsening of neurologic deficit occurred in 12.3%, a significant association was found in cervical tumors (p=0.048). The operative mortality was 5.8%, cervical tumors (p=0.05), postoperative complications (neurologic deficit (p=0.023), infection (p<0.001) and bedsore(P<0.001), and astrocytic tumors (p<0.001)were found to be independent risk factors for mortality. Although neurological improvement was seen in 87%, patients with preoperative poor ambulatory status (p<0.001) and sensory deficit (p=0.012) and discharged with worsened status (p<0.001)were found to be independent risk factors for poor neurologic outcome. Conclusion: Most of the patients improved in their clinical outcome, cervical tumors are prone to postop complications and mortality. Patients who came with poor neurologic status and sensory deficits will develop a poor neurologic outcome.
Predictors Of Relaparotomy For Persisting Intra Abdominal Infection In Secondary Peritonitis
(Addis Abeba University, 2020-11) Shiferaw, Abel; Dr.T/Selase, Henock (General Surgeon, Assistant Professor)
Introduction: Peritonitis is one of the commonest causes of acute abdomen in Ethiopia with high mortality and morbidity. One of the causes of high morbidity and mortality is persistent intraabdominal infection. Persistent intraabdominal infection is usually managed by relaparotomy in our setup. The two essential approaches for managing post op collection are RL on-demand (“wait and see” approach) and planned RL. Despite multiple studies, both have comparative mortality. These makes management of persistent intraabdominal infection challenging. This study aimed to identify Preoperative and intra operative clinical variables that are predictive of persistent intraabdominal infection. Objectives: The aim of this study is to identify preoperative and intraoperative clinical factors that may predict the need for relaparotomy in patients with complex intra-abdominal sepsis, in order to assist clinicians to decide timely intervention. Methods: A retrospective cross-sectional study was conducted on 172 cases of patients who were operated from Sept, 2018 to April , 2020 at two affiliated referral hospital of AAU, collage of Medicine, Addis Ababa; Yekatit 12 referral hospital and Minilik II referral Hospital. All of patients were cases of secondary peritonitis. Clinical progress of the patients from admission to discharge/death was documented. More than 20 preoperatve and intraoperative variables were analyzed to identify predictive model using logistic regression analysis. Results: Out of 172 patients with peritonitis included in this study, 70.9% were males. The Median age group of patients was 25 yrs. 82% of patients were referred from Addis Ababa (within the city). The median length of time from the onset of symptoms to seeking medical care was 3 days. The most common cause of secondary peritonitis was complicated appendicitis (52.9%), followed by perforated PUD (33.1%). Out of 172 laparotomy cases for secondary peritonitis, 40 (23.3%) required relaparotomy for postop collection. From Patients who developed postop collection, 45% of them were diagnosed after pus/Gi content leaked through the surgical wound. In Our study, the mortality rate of patients who develop postop collection and undergone relaparotomy was 27.5 % and 4.5% for those without postop collection. Logistic regression identified the following 4 variables as having strong predictive value: Duration of illness more than 5 days, Systolic BP 1000 ml and small bowel as source of contamination Conclusion: Management of persistent intra-abdominal infection is challenging. Sign and symptoms of persistent intra-abdominal infection are subtle, resulting late diagnosis after onset of MODS. Delay in diagnosis results in high mortality and morbidity. We have identified 4 preoperative and intraoperative variables available at first laparotomy to predict persistant intraabdominal infection requiring relaparotomy. These sets of variables can be a mile stone for future validation study before inserted into day to day clinical practice
Prospective study: early complications and short term neurologic outcome following posterior thoracolumbar pedicle screw fixations at two Ethiopian teaching hospitals, Addis Ababa, Ethiopia.
(Addis Abeba University, 2020-12) Leake, Merhawi; Abebe, Mersha(M.D, Associate Professor of Neurosurgery, AAU)
BACKGROUND: Pedicle screw fixation is a well-known and increasingly performed technique to achieve fixation and fusion especially in thoracolumbar region. This technique is used for variety of indications. Despite technical advances in screw fixations complications can happen intraoperative or postoperative, and still PSF is associated with a risk of complication. OBJECTIVE: To assess early complicat ions and short term neurologic outcome following thoracolumbar pedicle screw fixat ions at two Ethiopian teaching hospitals. METHODS: One year hospital-based prospective descriptive study was conducted on 68 patients that underwent posterior thoracolumbar pedicle screw fixation and fusion at ALERT and MCM hospitals from September 2019 to August 2020. To determine the existence and level of association between independent and dependent variables bivariate Pearson´s correlation analysis was done, and multiple regression analysis was also done to identify the existence of statistically significant association between independent variables and neurologic status at 3 rd month. RESULTS: 52 male and 16 female patients were included. The mean age was 31.79. Indications for hardware placement were trauma - 82.4 % (56 patients), degenerative and spondylolisthesis - 11.8% (8 patients), tumour - 2.9% (2 patients), infection - 1.5 % (1 patient), and one patient L2 screw fracture (previously PSF was done). A total of 351 screws were inserted. Most screws (76 screws - 21.7%) were inserted at the level of T12. Determined accuracy rate screws inserted was 88.0%, with screw malposition rate of 12%. Highest number of breech was found at the level of T12 - 9 breeches. Medial breech was the commonest (47.6 % of breeches, 20 screws), followed by anterior breech (38.09 %, 16 screws). Intra-op complications happened for 16 patients (23.5%), 8 were intra-op CSF leak, 7 - intra-op pedicle fracture, and one nerve root injury. Early post-op complications that happened during hospital stay were one deep SSI, two UTI, three HAI, and five bed sores. Complications after discharge were two superficial SSI, two UTI, seven additional bedsores. Revision surgery was done for two patients (2.9%). On neurologic evaluation at third month, 72.9% of patient (35 patients) were neurologically the same, 14.6% (7 patients) had some improvement, and 12.5% (6 patients) had significant improvement. The majority of patients 87.9% did not receive physiotherapy. With 95% CI, only the presence of associated other site of injury (P=0.02) and lower extremity power status (P=0.02) have moderate correlation with the development of in-patient complications with r value of .404 and .362 respectively. On multiple regression analysis pre-op sensory level has a negative and significant effect on neurologic outcome at third month (standardized beta = . -1.690). CONCLUSIONS: Trauma was the commonest indication for fixation. Based on our result finding posterior thoracolumbar pedicle screw fixations and fusions with can be done with acceptable complication rate and good recovery considering the limited resources. Since our follow-up period was only 3 month, we recommend further follow-up study of these patients for assessing late instrument related complications.
Post-operative Seizure Status Among Patients Operated for Brain Tumor with Seizure- Multicenter Retrospective Cross-sectional Study
(Addis Abeba University, 2020-12) Abdulahi, Mohammednur; Zewdie, Kibruyisfaw (MD, Assistant professor in Neurosurgery)
Background: Seizure is one of common presentations of brain tumor. Surgical resection is useful in controlling seizures and in eradicating the symptoms associated with compression. Objective: The aim of this research was to examine postoperative seizure status and factors significantly associated with postoperative seizure control following brain tumor surgery in patients with brain tumor and seizure. Methods: Multicenter retrospective cross-sectional study was conducted among 97 patients with brain tumor and seizure who had undergone initial surgery at three selected teaching hospitals in central Ethiopia from January 1, 2015 to December 31, 2019. Assessment of postsurgical seizure status were described using Engel’s classification of seizure: completely seizure free (Engel class I), and not seizure free (Engel classes II, III, IV). Demographic, seizure history, radiographic characteristics, histopathologic diagnosis, treatment, preoperative and postoperative antiepileptic drug use data were collected and analyzed for statistical association with postoperative seizure control using univariate and multivariate logistic regression analyses. P- Values of less than 0.05 and confidence level of 95% were considered to indicate statistical significance and strength of association respectively. Results: Ninety seven patients (60 females, 37 males) were included, with a mean age of 41.7 years and a median seizure duration of 8 months. There were generalized tonic-clonic seizures in 52 patients (53.6%).The histopathology confirmed meningioma in 71.1% (n = 69) of patients, low grade glioma in 12.4% (n = 12), and high grade glioma in 11.3% (n = 11) of patients. Gross total resection was achieved in 80.4% (n = 78) of patients and subtotal resection in 19.6% (n = 19) of patients. During a median follow-up of 6 months (range 3 months to 3 years), 66% of patients were seizure free (Engel’s Class I). Seizure freedom was predicted by gross total resection (adjusted OR 6.24, 95% CI: 1.79-21.71, P=0.004) and seizure duration ≤ 1 year before surgery (adjusted OR 3.60, 95% CI: 1.20-10.82, P=0.022) on multivariate analysis. Occurrence of postoperative weakness after surgery (adjusted OR 16.23, 95% CI: 2.57-103.09, P=0.003) and uncontrolled preoperative seizure (adjusted OR 4.69, 95% CI: 1.49-14.75, P=0.008) were found to be significant independent predictors associated with uncontrolled postoperative seizure status. Conclusions: Sixty six percent of brain tumor patients in this study were seizure-free following surgery. Specific variables that were strongly associated with seizure-free outcome included gross total resection and seizure duration ≤ 1 year prior to surgery. These findings suggest that strict preoperative seizure control, early surgical intervention, and complete tumor resection increases the chance of postoperative seizure control.
Outcomes of decompressive craniectomy in adults with severe traumatic brain injury.
(Addis Abeba University, 2020-12) Assefa, Samson; Biluts, Hagos(MD, Associate professor, Neurosurgery Unit, Department of surgery, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia )
Objective: The aim of this study is to assess the outcome of decompressive craniectomy in adult patients with severe traumatic brain injury and to identify factors responsible for poor outcome Methodology: A retrospective study of 36 patients with severe TBI who had undergone decompressive craniectomy in a period of 40 months (May 2017 to March 2020). Adult patients, aged between 15 and 73 years of both genders undergoing DC were selected. Variables assessed were Sex, age, presence of comorbid illness, mechanism of injury, presence of associated injury, pre-operative GCS and motor score, pupillary reaction, CT finding, degree of midline shift, the status of the basal cisterns, Rotterdam score, and timing of surgery. The outcome of patients was assessed using the Extended Glasgow Outcome Scale. Student’s t-test and Chi-square test were used to identify possible factors responsible for poor outcome. Results: 36 patients (31males and 5 females) underwent surgical decompressive craniectomy with a mean time of 25.6 hours (SD=26.2) after trauma. Mean age of patients was 33.39 years (SD=13.92), old (range: 15 to 73 years). The mean duration of follow up was 5.78months. 33.3% of patients had a favorable outcome (GOSE=5-8), 66.7% had unfavorable outcomes (GOSE= 14) and the mortality rate was 52.8%. Among patients that survived, 70% had a favorable outcome and 30% had an unfavorable outcomes. Cranioplasty was done in 11 of the discharged patients (61%). The mean timing of cranioplasty was 6.2 months post craniectomy. Patients with the following conditions had significantly worse outcomes; presence of associated extracranial injury, preoperative GCS ≤ 5, motor score of 2 to 3, abnormal pupillary reaction, absent basal cisterns on CT scan, and high Rotterdam score. There was also a significantly significant association between older age and mortality. Complications included hydrocephalus (one patient), surgical site infection (SSI) in nine patients, six of the SSI were infection of the bone flap kept in the abdomen. Conclusion: The result of this study indicates that the majority of survivors after decompressive craniectomy have a good functional outcome as analyzed by GOSE. Poor functional outcome and death were observed in patients having poor prognosticators. Improving patient selection may further improve outcome in these very severely brain-injured patients.
Delays in Laparatomy for Acute Abdomen: An Observational Study of Pre Hospital Factors, Conducted in two Hospitals (ZMH, MIIH) from January to June2020GC Addis Ababa, Ethiopia
(Addis Abeba University, 2021) Tadesse, Aemro; Dr.Tadesse, Amezene(Associate Professor, Consultant General and Pediatric surgery, AAU CHS TASH )
Surgical Acute Abdomen is an emergency that requires prompt surgical intervention. Multiple studies have established a direct link between delays in presentation and surgical outcome in terms of morbidity and mortality. There are 4 layers/levels within the healthcare system: the Environment, the Organization, the Health Care Team and the Patient. When analyzing delays it is prudent to identify deficiencies at all 4 levels of the healthcare model interventions to correct or mitigate deficiencies will be different at each. Even though reasons for delay are multi factorial, it is prudent to identify deficiencies at all 4 levels of the healthcare model. This study mainly focuses on the influences of patient and primary health care factors for surgical delay in pre hospital time. We tried to see why patients delay in seeking help, and some factors after reaching healthcare system. Studies that have attempted to describe factors that significantly affect Health Seeking Behaviour(HSB) during illness episodes can be broadly classified into two. Studies which emphasize the utilization of formal health system, or health care seeking behavior of people. These involve creating models that describe series of steps people take towards health care model such as The Anderson, pathway models .The Andersen healthcare utilization model is a conceptual model aimed at demonstrating the factors that lead to the use of health services. According to the model, usage of health services is determined by three dynamics: Predisposing, Enabling factors and Need. Our study is under the second group. The Second group of studies demonstrate that decision to engage with particular channel is influenced by variety of factors such as socioeconomic status, age ,sex ,social status, type of illness access to service and perceived quality of service. The second group comprises those studies which emphasize the process of illness or HSB. Focus on specific genres of determinants which lie between patients and services such as geographical social economic cultural and organizational factors.
Assessment of Coagulation Profile among Adult Cardiac Outpatient Department of Tikur Anbessa Hospital, Addis Ababa, Ethiopia.
(Addis Abeba University, 2021-02) Fantahun, Ibrahim; Bezabeh, Abebe(MD, Cardiothoracic Surgery)
Background; the coagulation process is initiated by platelets forming a plug at the location of the injury within few seconds of a breach in the vascular integrity. This constitutes the primary haemostatic mechanism. Secondary homeostasis is a multifaceted interaction between plasma coagulation factors, which results in the creation of fibrin strands strengthening the platelet plug. A hospital based cross sectional (retrospective chart review) study design was employed and simple random sampling techniques was used. Sample size is calculated by taking assumptions of 95% confidence level, there is no other study conducted related with this title to being use as a reference proportion so I took 50% (P=0.5) as a reference proportion. And adding 10 % nonrespondents rate. The total population under study, which means total patient number who attend cardiac clinic in last month, was 1000 so by using correction formula the sample size becomes 306. In this study we found that the mean INR value of a patient under study was 3.037 (SD: ±1.43) and the median was 2.9.While the quarantines was 2.0 – 3.65. According to our study, the data confirmed that the mean platelet count of the study unit was 282248(SD: ±89589). However, the mean PTT value of patients was 41.7 seconds (SD: ±11seconds). While the minimum PTT was 22 seconds and the maximum was 77 seconds. as this study is hospital based with limited representativeness population based studies are recommended.
Assessment of the Effect of Lactate on Patient Outcomes and Associated factors among Patients who Underwent Cardiopulmonary Bypass Surgery at Cardiac Center Ethiopia, Addis Ababa, Ethiopia 2021.
(Addis Abeba University, 2021-02) Tesfaye, Tigist; Dr. Bezabih, Abebe(Assistant professor)
Introduction: Hyperlactatemia and lactic acidosis are commonly encountered during and after cardiac surgery. Perioperative lactate production increases in the myocardium, skeletal muscle, lungs and in the splanchnic circulation during cardiopulmonary bypass. Hyperlactatemia is highly suggestive of tissue ischemia and is associated with a prolonged intensive care unit stay, a prolonged requirement for respiratory and cardiovascular support and increased postoperative mortality. Objective: The objective of the study was to assess effect of lactate on patient outcomes and associated factors among patients who underwent cardiopulmonary bypass surgery at Cardiac Center Ethiopia, Addis Ababa, Ethiopia from December 2020 to February 2021. Method: An institution-based retrospective cross-sectional study was done among all patients who underwent cardiopulmonary bypass surgery from December to January. Data was collected from patient chart review. The collected data was entered into Epidata version 4.2 and export to SPSS 23 for analysis. Descriptive statistics for categorical and continuous variables was done. A chi-square test was done to show the presence of an association between the outcome variable and independent variables. A variables fitted on bivariate analysis was entered into multivariable analysis to show the strength of association and statically significant variable. Result: The prevalence of hyperlactatemia in this study among patients who underwent cardiac surgery procedures at Cardiac Center Ethiopia was 37.5 %. Rise in lactate level prolongs ICU stay, Prolongs intubation duration and increase need of Inotropes support. Lactate level was measured on immediate postoperative day within 10 hours after the surgery and was defined as lactate level > 3 mmol/L in the first hour after surgery. Age > 50 years [AOR: 6.8 (95% CI 1.725), P=<0.008]. female gender [AOR: 1.8 (95% CI 1.1-3.8), P=0.048]. Variables statistically significant were declared at 95 % CI, p-value < 0.05. Conclusion and Recommended: Early rise in lactate level in patients who underwent cardiopulmonary bypass surgery is a strong and robust predictor of morbidity and mortality. Different patient and operative factors involved in this pathophysiology. As a result, strict follow up management of those factors are recommended.
Characteristic, Outcome and Associated factors of COVID 19 Cases Admitted to ICU and Mechanically Ventilated at Eka Kotebe General Hospital, Addis Ababa, Ethiopia, 2020: Retrospective Cross Sectional Study
(Addis Abeba University, 2021-02) Meded, Semira; Dr.Nega, Birhanu(Associate professor); Abagero, Abdulnasir(MPH, Resident Advisor Field Epidemiology program)
Introduction: As the COVID-19 pandemic is rapidly spreading throughout the world it has taken millions of lives. Among the population the critically ill and those who have other co morbidities are largely affected by it. In order to accommodate the growing number of critically ill patients and those who require mechanical ventilation hospitals are constantly expanding and trying to meet the overwhelming demand. Therefore, identifying COVID-19 characteristics, outcomes and associated factors among patients requiring mechanical ventilation is crucial for resource planning and proper management. This study is mainly aimed to assess the characteristic and outcome of COVID 19 cases admitted to ICU and mechanically ventilated patients. Objectives: The objective of this study is to assess characteristic, outcome and associated factors of COVID 19 cases admitted to ICU and mechanically ventilated at Eka Kotebe General Hospital. Study design: hospital based prospective cross sectional study design was used. Results: a total of 179 patients were included in this study and the 30 days mortality rate was 59.2 %. 77.1 % of the patients had comorbidities. Male gender, history of Diabetes, CKD and uses of vasopressor and laxatives were associated with 30 days patient mortality. Recommendation: We recommend that Male patients, patients diagnosed with Diabetes Miletus, CKD and who are receiving vasopressor therapy should be given a higher priority and carefully followed in the ICU to decrease the mortality rate.
Knowledge of Cardiovascular Disease Risk factors among Patients Attending Cardiac follow up Clinic in Tikur Anbesa Specialized Hospital.
(Addis Abeba University, 2021-02) Tesfaye, Azeb; Dr.Nega, Berhanu(Associate Professor of Surgery,Cardiothoracic Surgeon)
Introduction: as the largest single cause of death on the planet, cardiovascular disease (CVD) in all its forms is an important public health problem. CVD is not a single disease, but a cluster of diseases and injuries that affect the cardiovascular system. These are most commonly diseases of the heart and of the blood vessels of the heart and brain. In general they affect people in beginning and later life. The aim of this study is to asses Knowlegde of cardiovascular disease riskfactors among patients attending cardiac follow up clinic in Tikur Anbes Specialized Hospital. Methods: A Cross sectional study Design was conducted in Tikur anbesa specialized Hospital. The sample size of this study is 305. The sampling method of this study is systematic random sampling. Epi-info was used for data entry and SPSS for analysis. Descriptive statistics is applied for analysis and Mean, standard deviation, tables and graphs used for data summary and presentation. Result: Among of all the respondents, 163 (54.3%) had good knowledge while the rest 137 (45.7%) were found to be not knowledgeable. Two third of the respondents, 190 (63.3%), reported that Consumption of alcohol is not a risk factor for CVD while only the rest 110 (36.7%) reported alcohol is a risk factor for CVD. Considering Diabetes mellitus, 246 (82%) of them reported that having Diabetes mellitus is a risk factor for CVD. Conclusion: The knowledge of CVD patients in the current study area was found to be low. The habit of physical exercise of the study subjects is found to be poor with most of them travelling using cars or buses. The proportion of study subjects with risk factors like overweight, cigarette smoking and Alcohol consumption was found to be high. Ethiopian Federal ministry of health should focus on awareness raising programs including broadcasting messages for the whole population. Physical activities should be promoted by acknowledging and scale up the monthly street sport festivity to weekly or bi-weekly.

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