Surgery

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30 Day Perioperative Outcome and Associated Factors For Morbidity and Mortality of Patients that Undergo Elective Surgical Intervention for Colonic Cancer in Tikur Anbesa and Zewditu Memorial Hospital: A Cross-Sectional Prospective Study
(Addis Ababa University, 2024-12-10) Adamzer Mulugeta; Abel Shiferaw
Colorectal cancer remains a significant global health challenge, particularly in Ethiopia, where the incidence is rising. With this rise has come the increment of surgeries being done with curative intent with subsequent implications on morbidity and mortality of patients.
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.
A cross-sectional descriptive study on knowledge, attitude and perception of oral and maxillofacial surgery specialty among healthcare professionals in Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia
(Addis Ababa University, 2023-09) Tibebu, Hiwot Demisachew; Negussie,Samson (PhD); Adula, Surafel (PhD)
Background: Oral and maxillofacial surgery evolves around the head and neck region, and acts as a connecting bridge between medical and dental specialties. In many health services communities, the scope of oral and maxillofacial surgery (OMFS) as a discipline is frequently not probably understood. Good awareness of OMFS among different branches of health service providers is essential for better referral strategies and will be for the benefit of the patient. Objective: The main objective of this study is to assess the knowledge, attitude and perception of oral and maxillofacial surgery specialty among healthcare professionals at TikurAnbessa Specialized Hospital in Addis Ababa, Ethiopia. Method: A descriptive cross-sectional study design and a convenient sampling method isused. Self-administered questionnaires were prepared and filled out by the healthcare professionals. Descriptive statistics such as demographic data, knowledge, attitude and perception of study participants from their responses of the questionnaire were recorded and analyzed using SPSS version 25 software. Time frame: The study was conducted from December, 2022 to July, 2023. Result: A total of 125 healthcare professionals were participated in this study. Out of which, 75 were males and 50 were females. Most of participants were in the age range between 20 and 30 years. And, most of them have been in clinical practice in a range of 2 to 5 years. Regarding knowledge and attitude of healthcare professionals, the result of this study showed that 76 (60.8%) have poor knowledge and 49 (39.2) have good knowledge. Similarly, most participants have poor attitude towards oral and maxillofacial surgery specialty which accounts for about 79 (63.2%) of participants and 46 (36.8) of them have good attitude. On the contrary, the perception of healthcare professionals towards the level of oral and maxillofacial surgery service given in TikurAnbessa specialized hospital is good in majority of them (76, 60.8%) and the rest 49 (39.2%) participants have poor perception. Conclusion: The study concluded that there is poor knowledge and attitude of oral andmaxillofacial surgery specialty among study participants.
Acute Limb Ischemia Presentation and Outcome Among Cardiac Patients in Resource-Limited Setup, Single Institution Experience, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2024
(Addis Ababa University, 2024-12-13) Weini Tekle; Henok Teklesilasie
Acute Limb Ischemia (ALI) is a sudden drop in limb perfusion, posing a threat to viability. Cardiac conditions such as atrial fibrillation, valvular disease, and ischemic heart disease are major risk factors. In resource-limited settings like Tikur Anbessa Specialized Hospital, understanding ALI presentation and outcomes in cardiac patients is crucial for improving management and reducing morbidity and mortality
Analysis of Major Orthopedic Surgical Procedures at Black Lion Specialized Hospital, Addis Ababa University, Ethiopia
(Addis Ababa University, 2024-10-17) Mengistu Gebeyehu; Biruk. L
Musculoskeletal disease (MSD) is a major cause of disability in the global burden of disease, yet data regarding the magnitude of this burden in orthopedic surgical services in low and middle-income countries (LMICs) are lacking
Analysis of Postcholecystectomy Syndrome, Single Institution Experience, Zewditu Memorial Hospital, Addis Ababa, Ethiopia, 2024
(Addis Ababa University, 2024-12-13) Bamlack Shewandagn; Sahlu Wondimu
Gallstone disease ranks among the most prevalent surgical conditions, with cholecystectomy being the primary treatment for gallstones. Post-cholecystectomy syndrome (PCS) refers to a variety of symptoms that occur in patients following gallbladder removal
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.
Assessment of Characteristics and Outcome of Cardiac Patients who Underwent Open-heart Surgery at Cardiac Center of Ethiopia, FEB, 2009–DEC, 2020: Retrospective Cross Sectional Study
(Addis Abeba University, 2021-07) Amdihun, Rekiya; Dr. Bezabih, Abebe(Cardiothoracic surgeon)
Background: - The first successful open heart surgery using extracorporeal circulation technique was performed by John Gibbon in 1953 during an atrial septal defect closure. Cardiovascular diseases (CVD) are group of diseases and injuries that affect the cardiovascular system. As the main cause of death on the planet, cardiovascular disease (CVD) in all its forms is an important public health problem. Most commonly CVD affect the blood vessels of the heart and brain. In general they affect all people in both child and adulthood life. Objective:-The objective of this study is to assess characteristics and outcomes of patients who underwent open heart surgery from FEB, 2009 to DEC, 2020at cardiac center of Ethiopia. Method:-Institutional based cross-sectional study design was conducted. Sampling and Sample size determination: The sample size for the study was determined using single population proportion formula. And Simple random sampling retrospective chart review technique was used. RESULTS:-In this study a total of 320 patients were analyzed, from this 186 (58.1%)of the patients were female and 134(41.9%) were male. The majority of participants were found in the age group 6-18yrs 148(43.7%). The primary diagnosis from this study were ASD 54 (16.8%), VSD covered 42(13.1%), severe MR 40(12.5%). Only eight (2.5%) of patients had post-operative acute kidney injury and 5(1.6%) patients had post-operative bleeding. the immediate overall mortality were 3(0.9%). Conclusion and Recommendation: The present study had identified that more than half 58.1% of the patients were female. It also identified ASD the commonest CHDs followed by VSD. This study report that MV replacements were the most common valve surgery. Open heart surgery can be performed with excellent outcome in cardiac center of Ethiopia. We recommend that doing further research on associated factor for this outcome. That may better to know which variable has association for good outcome .and also quality improvement and increase number of surgeons is good for doing all the surgeries by local team.
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.
Assessment on Competency in Interpretation of Emergency CXR among Emergency and Critical Care Medicine residents in Ethiopia: A cross-sectional study
(Addis Ababa University, 2024-10-10) Misiker W/kidan; Merhai Kefyalew
The chest X-ray (CXR) is an important diagnostic tool in diagnosing and monitoring a spectrum of diseases. It has a crucial role in the clinical decision-making process. The chest radiograph is the most commonly performed radiologic examination and can be one of the most complex and most difficult to interpret. Emergency physicians and residents are required to interpret CXR. Competence in interpreting Emergency CXR is essential for emergency and critical care residents to ensure timely and accurate diagnosis and treatment. However, there is a lack of comprehensive studies in developing countries assessing the competency levels of emergency and critical care medicine residents
Audit of Operation Notes in Plastic and Reconstructive Surgery Unit, All Africa Leprosy Tuberculosis and Rehabilitation Training Center (ALERT) Hospital
(Addis Ababa University, 2021-12) Legesse, Hellina; Baraki, Ataklitie(MD, FCS-ECSA,Ass. Professor of surgery)
Introduction: High quality operation notes are one of the most crucial parts of patient care as it is a means of communication among professionals, source of data for audits and researches, and a source of information in court. The Royal College of Surgeons of England has produced a guideline in 2014 that outlines the minimum standards that need to be documented on operation notes. This study aims to assess the adherence of ALERT hospital plastic and reconstructive unit to these guidelines. Objectives: To evaluate operation notes in the plastic and reconstructive unit of ALERT hospital against RCSEng GSP 2014 standards, identify causes of incompleteness and suggest possible ways of improvement in the quality of operation notes. Methods: The study is conducted, plastic and reconstructive unit of ALERT hospital. It is a cross sectional retrospective study conducted using stratified random sampling of 341operation notes written since April 1, 2020, supplemented by survey questionnaire administered to 22 doctors (consultants, fellows and residents) to assess their experience and opinion regarding operation note standards. Results: None of the RCSEng GSP 2014 standards were consistently documented. Only 3 standards were documented in more than 90% of operation notes. Most operation notes were written by residents. Survey questionnaire administered results showed the participants believe that lack of quality of operation notes affects follow up and future interventions for patients. More than 95% of the respondents reported that they do not write all the standards consistently and most commonly attributed reasons are absence of formal education on the subject and operation note proforma incompleteness according to the standard. Among the measures suggested by the survey participants to improve the quality of operation note include introduction of formal teaching about operation note writing, updating the existing operation note proforma to include the RCSEng GSP 2014 standards and educating the staff about the standards. Conclusion: Operation notes in plastic and reconstructive surgery unit of ALERT hospital are not up to standard per RCSEng GSP 2014 guideline. Formal education, update of existing operation note proforma, posting aide memoires in the operation theatres and clinical education of the staff about the standards are some of the proposed solutions to improve the quality of the operation notes.
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.
Characteristics &Outcome of Femur Neck Fracture Patients Treated with Hemiarthroplasty at Tikur Anbessa Specialized Hospita
(Addis Ababa University, 2024-10-09) Teklegiworgis Gebremedhin; Biruk Lambisso
Femoral neck fractures are a common orthopedic injury, particularly in older adults. Hemiarthroplasty is a surgical procedure used to treat these fractures by replacing the damaged femoral head. However, the outcomes and patient profile following hemiarthroplasty in Ethiopia have not been well-studied.
Clinical and Functional Outcome of Anterior Tibialis Tendon Transfer for Recurrent Clubfoot in Tikur Anbessa Specialized Hospital: A 3-year Retrospective Cohort Study
(Addis Ababa University, 2024-09-10) Alazar Menbere; Birhanu Ayana
Clubfoot is a common foot deformity found in babies. The main aim of treatment is to make the foot look and function normally, without causing any pain. The Ponsetti method is the most widely used treatment, which has a success rate of 92%. However, about one-third of cases may experience relapse. In such cases, Tibialis anterior tendon transfer (TATT) is recommended for those above the age of three. Literature is scarce on the functional and clinical outcomes of TATT and the interplay between the two. Furthermore, factors which lead to poor outcomes are largely unexplored. Two cost-effective outcome assessment tools are the Oxford Ankle Foot Questionnaire and the Pirani/Bohm/Sinclair (PBS) score.
Clinical And Radiographic Evaluation of Posterior Cervical Arthrodesis and Stabilization Using Lateral Mass Screw and Rod at Alert Hospital,Addis Ababa, Ethiopia
(Addis Ababa University, 2024-10-19) Surafel Mekonnen; Azarias Kassahun
Lateral mass screw and rod fixation is the most practiced instrumentation for posterior cervical arthrodesis and stabilization for indication of cervical instability, trauma, neoplasm, decompression, and deformity correction. There is paucity of data in clinical and radiologic evaluation of Lateral mass screw and rod fixation especially in our setup.
Clinical Features and Histopathologic Distribution of Granuloma in Colonoscopy Biopsy
(Addis Ababa University, 2024-12-09) Natnael Gebeyehu; Abel Shiferaw
Histopathologic examination of colonoscopy biopsies is vital for diagnosing gastrointestinal diseases. Granulomas, focal aggregates of immune cells associated with chronic inflammation, are a key area of study. They can be categorized into foreign body granulomas, which isolate non-reactive substances without a T cell response, and immune granulomas, which involve continuous T cell-mediated reactions. Granulomas exhibit various patterns, such as foreign body, epithelioid, xanthogranulomatous, suppurative, and necrotizing types, each indicating different causes. They can result from infections such as TB, non-infectious conditions like Crohn’s disease, drug reactions, inherited disorders, malignancies, or idiopathic conditions. Accurate classification is crucial for effective management, ranging from antimicrobial therapy to immunosuppressive treatment. Despite challenges in granuloma distribution and morphology, histopathology remains essential for diagnosing intestinal granulomatous disease and differentiating between IBD subtypes and other conditions
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.
Correlation of Preoperative Urine Culture and Post Pcnl Stone Culture and their Association with Post PCNLSIRS
(Addis Ababa University, 2024-10-09) Sadam Aliye; Abeselom Lemma
Under ideal conditions PCNL has a stone clearance rate of over 90%. However, after PCNL, 10% to 35% of patients experience a systemic inflammatory reaction, and a small proportion progresses to sepsis
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.

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