Survival status and predictors of mortality among emergency laparotomy patients in selected governmental hospital in Addis Ababa, Ethiopia; multicenter retrospective cohort study
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Date
2024-06
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Addis Ababa University
Abstract
Background: World-widely, emergency laparotomy is a widely performed surgical procedure
with high-risk surgery and anesthesia that is challenging and related to high morbidity and
mortality. The mortality rate is significant in both developed and developing countries, however,
the highest mortality rates are in low and middle income countries. The aim of this study is to
determine the impact of factors in time dependent manner among emergency laparotomy
patients.
Objective: To assess survival status and predictors of mortality among emergency laparotomy
patients in Addis Ababa governmental hospitals, Ethiopia, from January 1, 2020 to January1
2023.
Method: An institution-based, multicenter retrospective cohort study was conducted at four
selected Addis Ababa governmental hospitals among emergency laparotomy patients from
January 1, 2020, to January 1, 2023. Each sample patient chart was selected by using a
systematic random sampling technique to select 379 patients chart. Data were entered into Epi
Data version 4.6.0.2 and analyzed using STATA version 17. A standard Cox-proportional
hazards regression analysis model was used to correlate each independent variables with the
dependent variables. Both bi-variable regression and multiple cox-regression were fitted to
identify predictors of each outcome. Kaplan-Meier graphs are used for estimation. The hazard
ratio and its 95% confidence interval were computed, and factors with a p-value of less than
0.05 in the multivariable model were strongly correlated with the mortality of patients who
underwent emergency laparotomies.
Result: A total of 374 patients were followed retrospectively from a sample of 379 patients, with
a median follow-up time of 19 days. The overall mortality of patients who underwent emergency
laparotomy was 10.43%. Factors such as preexisting disease (AHR=5.43, 95%CI: 1.56, 18.97),
preoperative sepsis (AHR=1.2, 95%CI: 1.03, 3.47), intraoperative vasopressor use (AHR=8.49,
95%CI: 1.69, 42.65), and post-operative complications (AHR=3.73, 95%:1.02, 13.65) were
significantly associated with mortality in patients who underwent emergency laparotomy.
Conclusion: The overall mortality rate among patients who underwent emergency laparotomy
was high compared to previous studies. Preexisting disease, preoperative sepsis, and
intraoperative vasopressor use, and postoperative complication were a significant factor.
Therefore, optimization is needed before operation for critically ill patients with sepsis.
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Keywords
Emergency Laparotomy, Mortality, Predictor’s, Survival Status