Daytime Versus Night-Time Emergency Abdominal Operations: Perspective from a Low–Middle-Income Country

Emergency abdominal operations carry significant risk of mortality and morbidity. The time of the day when such operations are performed has been suggested as a predictor of outcome. A retrospective comparison of outcomes of daytime and night-time emergency abdominal operations was conducted. Clinical data of patients who had abdominal operations over a five-year period were obtained. Operations were classified as ‘daytime’ (group A) if performed between 8.00 am and 7.59 pm or ‘night time’ if performed between 8.00 pm and 7.59 am (group B). Post-operative outcomes were compared. A total of 267 emergency abdominal operations were analysed: 161 (60.3%) were performed in the daytime while 106 (39.7%) were performed at night. The case mix in both groups was similar with appendectomies, bowel resections and closure of bowel perforations accounting for the majority. Baseline characteristics and intra-operative parameters were similar except that ‘daytime’ operations had more consultant participation (p = 0.01). Mortality rates (13.7% in group A and 12.3% in group B, p = 0.2), re-operation rates (9.3% in group A and 10.4% in group B, p = 0.7) and duration of hospital stay (group A—11.1 days, group B—12.4 days p = 0.4) were similar. ASA status, re-operation and admission into the intensive care unit were identified as predictors of mortality. Timing of emergency abdominal operations did not influence outcomes. In resource-limited settings where access to the operating room is competitive, delaying operations till daytime may be counterproductive. Patients’ clinical condition still remains the most important parameter guiding time of operation.     

Causes and determinants of outcome of intestinal perforations in a semiurban African community

Background: Intestinal perforations are common causes of generalized peritonitis, it is often severe because of faecal contamination and overwhelming sepsis resulting in high morbidity and mortality. The purpose of the present study was to determine the causes and factors affecting the prognosis in patients with generalized peritonitis as a result of intestinal perforation. Study design: Patients with acute generalized peritonitis from intestinal perforation were prospectively studied during a 6‐year period from 1995 to 2000. Personal, preoperative and postoperative clinical information of all the patients was entered into a predesigned proforma. Data were analysed and the effect of individual causes of peritonitis on the postoperative outcome was determined. Results: More males were affected by a ratio of 3 : 1, with the overall mean age of 27.6 ± 18.3 years (SD). The mean age in patients with typhoid perforation was 21 ± 14 years (SD) and highest in traumatic intestinal perforations (47.2 ± 17.6 years, SD). Typhoid perforation occurred in 75 (58%) patients, acute appendicitis in 21 (16.3%), peptic ulcer disease in 18 (14%), trauma in eight (6.3%), five were idiopathic and one malignant sigmoid carcinoid tumour. Wound infection occurred in 74 (58.3%) and mortality in 24 (18.8%) of the patients. Mortality was high in traumatic and typhoid intestinal perforation than other causes of intestinal perforation. Factors such as age, cause of intestinal perforation, and amount of pus drained during operation independently predicts the postoperative morbidity and mortality rates. Conclusion: Typhoid intestinal perforation was the most common cause of acute generalized peritonitis, followed by perforated acute appendicitis. Prognostic factors include age, the causes of perforation, amount of pus, wound infection, wound dehiscence, faecal fistula, and intra‐abdominal abscess.      

Factors affecting reversal following Hartmann’s procedure: Experience from two district general hospitals in the UK

Purpose  

Restoration of gastrointestinal continuity following Hartmann’s procedure is a challenging task associated with significant morbidity and mortality. New strategies to avoid a stoma are not readily available in general hospitals. Knowledge of the factors related to reversal is required to develop treatment strategies and counsel patients realistically. The present study was conducted to determine the reversal rate and factors affecting Hartmann’s reversal in our practice.