PERIOPERATIVE OUTCOMES AND ASSOCIATED FACTORS AMONG ADULT PATIENTS UNDERGOING LAPAROTOMY FOR N O N-TRAUMATIC ACUTE ABDOMEN: A MULTI-CENTER COHORT STUDY, HARAR, E A S T E R N E T HI OPI A

Abstract

The term acute abdomen designates symptoms and signs of intra-abdominal disease usually treated best by surgical operation. The proper management of patients with acute abdominal pain requires a timely decision about the need for surgical operation. However, evidence regarding this issue is limited in Hiwot Fana Comprehensive specialized University Hospital and Jugol General Hospital , which are the study areas. Therefore, doing this study will reduce those limitations regarding perioperative outcomes of surgically treated non-traumatic acute abdomen and associated factors in adult patients in these two hospitals. Objective: This study aimed to assess perioperative outcomes and associated factors among patients undergoing laparotomy for non-traumatic acute abdomen at Hiwot Fana Comprehensive specialized University Hospital and Jugol General Hospital from July 1 to October 31, 2024. A facility based prospective cohort study design was conducted in two public hospitals found in Harar town, Eastern Ethiopia from July 1 to October 31, 2024. A total of 141 adult patients underwent laparotomy for non-traumatic acute abdomen. Postoperative morbidity and mortality within 30 days of surgery were assessed. Data was collected using structured checklists. The collected data entered into Kobo tool box and exported to STATA version 17 for further analysis. A Kaplan-Meier analysis was used for categorical variables, and a log-rank test was used to determine the statistically significant difference between variables. A Cox regression analysis was conducted to identify factors associated to time to develop complications.The overall rate of unfavorable outcome was 13.5% and 29.08% of the cases developed postoperative complications. The hazard of developing unfavorable treatment outcomes among those with preoperative shock was 33.19 times higher than those without preoperative shock (AHR 33.191, 95% CI [1.376, 800.464]). Fever was another significant factor, with an AHR of 16.474, 95% CI [1.372, 197.756], indicating that patients with fever were more than sixteen times more likely to develop unfavorable treatment outcomes. Age above 50 years was also another factor with AHR of 13.950, 95% CI [1.551, 125.493]. The mortality rate in this study was 8.5%. Conclusion: Patients who had shock, fever, and age above 50 years are at increased risk for unfavorable perioperative outcomes. Therefore, due attention should be given to those patients who are going for laparotomy after presented with shock and fever. Clinicians may use these results to optimize these patients to decrease their elevated risk of serious morbidity and mortality.