Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana

Background: Perioperative mortality rate (POMR) has been identified as an important measure of access to safe surgical and anesthesia care in global surgery. There has been limited study on this measure in rural Ghana. In order to identify areas for future quality improvement efforts, we aimed to as...

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Autores principales:	Brandon S. Hendriksen, Laura Keeney, David Morrell, Xavier Candela, John Oh, Christopher S. Hollenbeak, Temitope E. Arkorful, Richard Ofosu-Akromah, Evans K. Marfo, Forster Amponsah-Manu
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2020
Materias:	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/00f89ad0a54b4417b983fc6d1ca48f8c
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spelling	oai:doaj.org-article:00f89ad0a54b4417b983fc6d1ca48f8c2021-12-02T06:21:26ZEpidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana2214-999610.5334/aogh.2586https://doaj.org/article/00f89ad0a54b4417b983fc6d1ca48f8c2020-02-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/2586https://doaj.org/toc/2214-9996Background: Perioperative mortality rate (POMR) has been identified as an important measure of access to safe surgical and anesthesia care in global surgery. There has been limited study on this measure in rural Ghana. In order to identify areas for future quality improvement efforts, we aimed to assess the epidemiology of exploratory laparotomy and to investigate POMR as a benchmark quality measure. Methods: Surgical records were reviewed at a regional referral hospital in Eastern Region, Ghana to identify cases of exploratory laparotomy from July 2017 through June 2018. Patient demographics, health information, and outcomes data were collected. Logistic regression was used to identify predictors of perioperative mortality. Findings: The study included operations for 286 adult and 60 pediatric patients. Only 60% of patients were covered by National Health Insurance (NHI). The overall POMR was 11.5% (12.6% adults; 6.7% pediatric). Sixty percent of mortalities were referrals from outside hospitals and the mortality rate for referrals was 13.5%. Odds of mortality was 13 times greater with perforated peptic ulcer disease (OR = 13.1, p = 0.025) and 12 times greater with trauma (OR = 11.7, p = 0.042) when compared to the most common operation. Female sex (OR = 0.3, p = 0.016) and NHI (OR = 0.4, p = 0.031) were protective variables. Individuals 60 years and older (OR = 3.3, p = 0.016) had higher mortality. Conclusion: POMR can be an important outcome and quality indicator for rural populations. Interventions aimed at decreasing emergent hernia repair, preventing perforation of peptic ulcer disease, improving rural infrastructure for response to major trauma, and increasing NHI coverage may improve POMR in rural Ghana.Brandon S. HendriksenLaura KeeneyDavid MorrellXavier CandelaJohn OhChristopher S. HollenbeakTemitope E. ArkorfulRichard Ofosu-AkromahEvans K. MarfoForster Amponsah-ManuUbiquity PressarticleInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 86, Iss 1 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Brandon S. Hendriksen Laura Keeney David Morrell Xavier Candela John Oh Christopher S. Hollenbeak Temitope E. Arkorful Richard Ofosu-Akromah Evans K. Marfo Forster Amponsah-Manu Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana
description	Background: Perioperative mortality rate (POMR) has been identified as an important measure of access to safe surgical and anesthesia care in global surgery. There has been limited study on this measure in rural Ghana. In order to identify areas for future quality improvement efforts, we aimed to assess the epidemiology of exploratory laparotomy and to investigate POMR as a benchmark quality measure. Methods: Surgical records were reviewed at a regional referral hospital in Eastern Region, Ghana to identify cases of exploratory laparotomy from July 2017 through June 2018. Patient demographics, health information, and outcomes data were collected. Logistic regression was used to identify predictors of perioperative mortality. Findings: The study included operations for 286 adult and 60 pediatric patients. Only 60% of patients were covered by National Health Insurance (NHI). The overall POMR was 11.5% (12.6% adults; 6.7% pediatric). Sixty percent of mortalities were referrals from outside hospitals and the mortality rate for referrals was 13.5%. Odds of mortality was 13 times greater with perforated peptic ulcer disease (OR = 13.1, p = 0.025) and 12 times greater with trauma (OR = 11.7, p = 0.042) when compared to the most common operation. Female sex (OR = 0.3, p = 0.016) and NHI (OR = 0.4, p = 0.031) were protective variables. Individuals 60 years and older (OR = 3.3, p = 0.016) had higher mortality. Conclusion: POMR can be an important outcome and quality indicator for rural populations. Interventions aimed at decreasing emergent hernia repair, preventing perforation of peptic ulcer disease, improving rural infrastructure for response to major trauma, and increasing NHI coverage may improve POMR in rural Ghana.
format	article
author	Brandon S. Hendriksen Laura Keeney David Morrell Xavier Candela John Oh Christopher S. Hollenbeak Temitope E. Arkorful Richard Ofosu-Akromah Evans K. Marfo Forster Amponsah-Manu
author_facet	Brandon S. Hendriksen Laura Keeney David Morrell Xavier Candela John Oh Christopher S. Hollenbeak Temitope E. Arkorful Richard Ofosu-Akromah Evans K. Marfo Forster Amponsah-Manu
author_sort	Brandon S. Hendriksen
title	Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana
title_short	Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana
title_full	Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana
title_fullStr	Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana
title_full_unstemmed	Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana
title_sort	epidemiology and perioperative mortality of exploratory laparotomy in rural ghana
publisher	Ubiquity Press
publishDate	2020
url	https://doaj.org/article/00f89ad0a54b4417b983fc6d1ca48f8c
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Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana

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