T. J. Jaraczewski1, T. Esayas3, W. Melaku3, Y. Nigussie3, A. Gadisa3, B. M. Abebe3, S. N. Zafar2 1Medical College Of Wisconsin, Surgery, Milwaukee, WI, USA 2University Of Wisconsin, Surgery, Madison, WI, USA 3Hawassa University Comprehensive Specialized Hospital, Surgery, Hawassa, SIDAMA, Ethiopia
Introduction: Small bowel obstruction (SBO) is one of the most common emergency general surgical conditions in low- and middle-income countries (LMICs) and a significant cause of death and disability. Understanding the predictors of mortality post-SBO is crucial for early intervention, better patient management, and improving survival rates. This study seeks to explore the determinants of 30-day mortality among patients with SBO who undergo exploratory laparotomy at Hawassa University Comprehensive Specialized Hospital (HUCSH) in Hawassa, Ethiopia.
Methods: This is a single institution retrospective cross-sectional study conducted at HUCSH. We included data from all patients who underwent laparotomy for SBO between May 2018 – May 2023. The primary outcome of interest was postoperative 30-day mortality. We tested for associations between mortality and patient factors including, demographics, surgical history, duration of symptoms, lab values, intra operative findings, and post operative complications using univariable and multivariable logistic regression analysis. Factors found to be significant in the univariable analysis were utilized for the multivariable logistic regression model. Statistical significance was set as P < 0.05.
Results:A total of 217 patients met inclusion criteria. The cohort was made up of 61.8% (N=134) males and had a mean age of 31.8 +/- 13.1 years. Most patients came from the Oromia region (50.7%, N=110) followed by the Sidama region (35.9%, N=78). Of all the operations 56.2% (N=122) performed an anastomosis and 52.1% (N=113) had non-viable bowel. Total deaths were 15.2% (N=33). On univariate analysis sex (P=0.010), time to hospital (P=0.027), preoperative hemoglobin level (P=0.007), operative anastomosis (P=0.005), presence of non-viable bowel (P<0.001), length of non-viable bowel (P<0.001), reoperation during index hospitalization (P=0.001), postoperative pneumonia (P<0.001), and postoperative SSI (P<0.001) were associated with 30-day mortality. On multivariate analysis male sex (OR = 5.63, [1.74, 18.20]), preoperative anemia (OR = 20.9, [1.55, 282.98]), postoperative pneumonia (OR = 10.09, [2.67, 38.22]), and postoperative SSI (OR 13.71 [3.69, 50.97]) were found to be predictive of mortality.
Conclusion: In this study we found a mortality rate of 15.2%, which is similar to other studies performed in low-income countries; however, was higher than studies performed in high income countries (around 7% mortality). Multivariable analysis uncovered a number of factors spanning from demographics, to preoperative labs, to postoperative complications that were predictive of mortality. Future work will leverage this data to perform a comprehensive quality improvement study to work toward mitigating risks and improving patient outcomes.