THE PREVALENCE, CAUSAL PATTERN AND OUTCOME OF EARLY RELAPAROTOMY PATIENTS AT HIWOT FANA SPECIALIZED UNIVERSITY HOSPITAL SURGERY WARD, EASTERN ETHIOPIA

Abstract

Relaparotomy is performed in 20%-40% of patients with severe peritonitis in the abdominal cavity. The Magnitude of relaparotomy ranges from 0.5-15% in various reported studies. The most common causes requiring relaparotomy are peritonitis, evisceration, and bleeding. Relaparotomy was associated with significant morbidity and mortality risk. Objectives: To assess the Prevalence, Causal pattern and Outcome of early Relaparotomy patients at Hiwot Fana Specialized University Hospital (HFSUH) Surgery Ward, Eastern Ethiopia, from September 1, 2016 to August 31, 2020. Method: Hospital based document review Cross-Sectional study design was conducted for patients who underwent relaparotomy at HFSUH, Surgery ward from September 1, 2016 to August 31, 2020. The data was collected from August 1 to August 30, 2020. The calculated sample size determined was 89. But, all patients who underwent relaparotomy were included in the study irrespective of sample size. The data collection was conducted by using pre-tested structured questionnaire from patient charts. The data was entered, cleaned and analyzed by using SPSS version 20. Descriptive statistics were employed for all independent and dependent variable in the form text, tables and pie charts and bar graphs. Bi-variable and multivariable binary logistic regression were employed to determine the effect of independent variable on the outcome variable. The cut point used for statistical significance was at p value less than 0.05. Result: From the total of 1335 laparotomies done in four years, relaparotomy was done in 91 patients from Operation room logbook. With this the prevalence of relaparotomy was 6.8%. From those 91 patients who underwent relaparotomy, 9 were excluded due to incomplete data and the remaining 82 patients were analyzed. From 82 patients, 53 (64.6%) of them were males and 29 (35.4%) were females. The mean (+SD) age of patients was 33.32 +16.63 years. The most common indications for relaparotomy were intra-abdominal collection 22(26.8%) and anastomotic leak 20(24.4%). 61(74.4%) patients were developed post relaparotomy complications and the overall the mortality rate was 30(36.6%). There is significant association between mortality after relaparotomy and post-operative sepsis and septic shock (p=0.000, AOR=15.76; 95%CI: 2.91-85.41) and also with post-operative multi-organ failure (p=0.000, AOR=8.46; 95%CI: 1.275-56.11). Conclusion: The prevalence of Relaparotomy in our setup was 6.8%. Intra-abdominal collection and anastomotic leak are the most common indications of relaparotomy. The overall morbidity and mortality rate after relaparotomy was high in our setup. Keywords: Early