Abdominal Surgical Emergencies at Tikur Anbessa Specialized Hospital in Ethiopia; A Shifting Paradigm

Background: Developing nations in Africa may be experiencing changing demographics for abdominal surgical emergencies. In the past, intestinal obstruction has been the major diagnosis, but this may be changing.¹²³ This study analyzed the causes and outcomes for abdominal surgical emergencies (ASE) in Tikur Anbessa Specialty Hospital (TASH) in Addis Ababa, Ethiopia.
Methods: TASH is a tertiary medical center and teaching hospital. This is retrospective study included patients treated for ASE from July 1, 2010 to June 30, 2012. Information was collected in de-identified manner for analysis from the operating room logbook and from chart review. We analyzed demographics, clinical presentation and outcomes of emergency surgery in these patents using SAS 9.2 software. Univariant analysis was performed. P value < 0.05 was considered significant.
Results: A total of 530 patients presented with ASE, representing 18.6% of all surgical emergencies. Of these, 328 charts were available for review. 237 (72.3%) were males and the mean age was 36 years. Appendicitis (simple and complicated combined) were the most common cause of ASE accounting for 92 (28.0%). Bowel obstruction and penetrating trauma were present in 17% and 13% of the time respectively. The Overall Morbidity and mortality rates were 30% and 18% respectively. Wound infection and Pneumonia were the two most common post operative complications accounting for 25% and 12% respectively. A total of 61 patients (18.6%) died following ASE. Septic complications accounted for over 50% of the death. Mortality was significantly higher in patients with age >60 years (p< 0.0001) and in those who developed post operative complications. (p< 0.0001)
Conclusion: The causes for ASE at TASH in Ethiopia have changed with appendicitis being the most common. This study shows a higher morbidity and mortality rates when compared to previous reports. Further study is required to understand better specific interventions needed to reduce this high mortality due to sepsis.