Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study

Abstract

Background

Acute sigmoid volvulus is a surgical emergency with closed-loop obstruction of the colon that often requires emergency laparotomy, which is associated with a multitude of post-operative complications. Although sigmoid volvulus is the main cause of intestinal obstruction in Ethiopia, local studies of its management outcomes are limited.

Objective

To assess the magnitude and predictors of adverse perioperative outcomes of emergency laparotomy for acute sigmoid volvulus in the Debre Markos Comprehensive Specialized Hospital (DMCSH), Amhara region, Ethiopia in 2023.

Methods

This was a retrospective follow-up study. Descriptive statistics were used to measure perioperative outcomes and other study variables. Bivariable and multivariable logistic regression models were used to identify the predictors of adverse surgical outcomes. Associations were considered significant at p < 0.05 (95% confidence interval).

Results

In total, 170 study participants were enrolled, with a response rate of 91.4%. Forty-nine patients (28.8%) developed perioperative adverse outcomes. Pneumonia (29 patients, 28.1%), surgical site infection (19 patients, 18.4%), and wound dehiscence (10 patients, 9.7%) were the most common complications. Pre-operative shock [AOR: 3.87 (95% CI: (1.22, 12.28))], pus or fecal matter contamination of the peritoneum [AOR: 4.43 (95% CI: (1.35, 14.47)], and a higher American Society of Anesthesiologists (ASA) score [AOR: 2.37 (95% CI: (1.05, 5.34))] were identified as predictors of perioperative adverse events.

Conclusion

The perioperative adverse outcomes in this study were higher than those reported in Ethiopian national and global reports following emergency laparotomies. Hypotension at presentation, pus and/or fecal matter contamination of the peritoneum, and higher ASA scores are strong predictors of increased perioperative adverse outcomes. Therefore, healthcare providers and institutions involved in the delivery of emergency surgical care should emphasize the importance of early surgical intervention, adequate resuscitation, and patient monitoring to improve perioperative outcomes.

Keywords:

• sigmoid volvulus
• perioperative outcome
• emergency laparotomy
• Ethiopia

Abbreviations

AOR, Adjusted Odds Ratio; ASA, American Society of Anesthesiologists; AWHSC, Asrat Waldeyes Health Science Campus; CI, Confidence Interval; CT, Computed Tomography; DBU, Debre Berhan University; DMCSH, Debre Markos Comprehensive Specialized Hospital; EL, Emergency laparotomy; EOPD, emergency outpatient department; ETB, Ethiopian Birr; HIMS, Health Information Management System; ICU, Intensive Care Unit; LMICs, Low- and Middle-Income Countries; mmHg, Millimeter Mercury; PACU, Post Anesthesia Care Unit; USA, United States of America; WHO, World Health Organization.

Data Sharing Statement

The raw data can be accessed in response to reasonable requests from the corresponding author of this paper.

Ethical Approval and Consent to Participate

Ethical clearance was obtained, and the need for written informed consent was waived by the ethical review board of Debre Berhan University, Asrat Waldeyes Health Science Campus (IRB-158). Subsequently, permission was obtained from the Debre Markos Comprehensive Specialized Referral Hospital Quality Assurance Office, relevant departments, and unit heads of the hospital. No personal identifiers were included in the patients’ medical records during data extraction; therefore, it did not inflict any harm to the patients. All information used from the charts was kept confidential, and all methods were performed in accordance with the relevant guidelines and complies with the Declaration of Helsinki.

Acknowledgments

We extend our sincere gratitude to the research team members, who contributed to the completion of this study. Finally, we would like to express our heartfelt gratitude to all participants, data collectors, and supervisors for their time and effort.

Disclosure

The authors declare no conflicts of interest.

Additional information

Funding

There are no specific grants for this research from funding agencies in the public, commercial, or non-profit sectors.