Delay of emergency surgical interventions in Ethiopia: Patient and health system factors

Background
The objectives of this study were to evaluate outcomes among patients with acute abdomen and abdominal trauma who pre- sented at either of 2 referral hospitals in Addis Ababa, Ethiopia, and to determine the factors associated with delay as well as the effects of prehospital and in-hospital delay on outcome.
Methods
We conducted a 1-year prospective cross-sectional study, which included all cases of surgically treated acute abdomen and ab- dominal trauma admitted to St Paul General Specialized Hospital, Addis Ababa, Ethiopia and Gondar University Hospital, Gondar, Ethiopia. Standardized data collection forms were completed for all cases from 1 May 2008 to 30 April 2009. Data were analyzed using Epi Info version 6 and SPSS version 13.
Results
A total of 504 patients were studied. Diagnoses were: intestinal obstruction (34.6 %), appendicitis (33 %), and perforated peptic ulcer (3.6 %). Sixty-six percent of patients over 45 years of age, 60% of females, and 61% of intestinal obstruction cases were op- erated on within 3 days of illness onset. The 35% of patients who were operated on more than 3 days after the development of symptoms had a mortality of 67%. Fifty-four percent of the cases with a total prehospital and in-hospital time of more than 3 days had initially visited other health institutions.
Conclusions
Delay of surgical intervention of more than 3 days for acute abdomen or abdominal trauma adversely affected outcomes. Women, patients older than 45 years of age, patients with intestinal obstruction, and those who were referred from other health facilities were delayed and had adverse outcomes.

Keywords
delay in surgery; acute abdomen; abdominal trauma; surgical systems improvement