Abdominal re-operations: indications, early surgical outcomes and prognostic factors at Bugando Medical Centre, Mwanza Tanzania

Abstract

Background: Abdominal re-operation is any repeated operation for an intra-abdominal procedure or wound complication on index admission or on a subsequent admission to the hospital within a post-operative period of sixty days. It is usually performed in case of post-operative complications either as a re-laparotomy, stoma or wound complications depending on the initial type of surgery. Incidence of abdominal re-operation differs according to the hospital’s settings, patient’s baseline clinical condition and type of primary abdominal surgery. Despite the increased number of surgical re-admissions, and post-operative complications, there is still a paucity of data describing burden, indications, outcomes and prognostic factors of abdominal re-operations at Bugando Medical Centre (BMC). This study was conducted to determine indications, early surgical outcomes and prognostic factors for abdominal re-operations at BMC.

Methods: This was an analytical cross-sectional study that was conducted at BMC from May 2017 to May 2018. Data were entered into a Microsoft Excel sheet and statistical analysis was done using STATA version 15.

Results: A total of 104 patients were enrolled, of whom 41(39.4%) were males and 63(60.6%) were females, giving a male-to-female ratio of 1: 1.5. Their ages at diagnosis ranged from 1 day to 76 years with a median age of 29 [IQR 17 – 46] years. The most common indications for abdominal re-operation were peritonitis 45 (43.3%), burst abdomen 29 (28.0%) and anastomotic leak 18 (17.3%).  Stoma complications 7 (6.7%), haemorrhage 4 (3.9%) and post-operative paralytic ileus 1 (1.0%) were also recorded indications but at a lesser frequency. The mortality rate following abdominal re-operation was 28.9% (n=30). Older age and increasing number of abdominal re-operations were the main independent predictors of mortality following abdominal re-operations (p < 0.001).

Conclusion: Abdominal re-operation is associated with high mortality. The most common indications for abdominal re-operation were peritonitis, burst abdomen and anastomotic leak. Predictors of mortality were older age and an increasing number of abdominal re-operations. Hence it is recommended that patients with peritonitis, burst abdomen or anastomotic leak be managed in a timely and well-planned manner to minimize the number of unnecessary re-operations which may increase the risk for mortality.