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Background: The definition of high- risk surgical procedure is that procedure with at least 5% risk of mortality and these procedures are found in combination of advanced age, co- morbidities and emergency surgeries. Aim: This study aimed at identifying the short-term postoperative outcomes in high- risk adult surgical patients who had abdominal surgeries. Patients and Methods: A cross sectional analytical hospital based study was done, involving 197 patients aged 18 years and above, who had abdominal surgeries between August 2011 and March 2012. Of 197, 163 patients were purposively studied after meeting at least one of the criteria of inclusion. The measures of postoperative outcomes were inpatient mortality, short-term complications and hospital stay. The data were collected using structured forms, entered and analyzed with SPSS Version 16.0 computer program. Chi-Square test was used to test the significance of dependency and/or differences for categorical data and Binary Logistic regression analysis were performed when predictors of the outcome for categorical data were sought. Odds ratio at 95% confidence interval was used as a measure of association. A p-value of < 5% was considered significant. Results: Among 163 patients studied during the study period, majority were male (57.7%) and of age 60 years or younger (71.8%). Mean age of patients was 49.2 years, ranging from 18 to 90 years. The proportion of high-risk adult abdominal surgeries was 82.7%. Of 163 patients, the frequently observed surgical conditions operated were emergency cases (65.6%), commonly peritonitis and intestinal obstruction (35.0% and 28.8% respectively). Among 107 emergency cases, quarter of them (25.0%) had symptoms of illness for more than 5 days and that significantly contributed to mortality (OR = 3.3 ). Co-morbidity was recorded in 26 (16.0%) with Hypertensive Heart Disease having the highest proportion (19.8%). Presence of co-morbidity contributed mortality in 26.9% compared to non-co-morbid patients (17.5%); however, it was statistically insignificant. Co-morbidity slightly increased hospital stay. Overall, 92 patients (56.4 %) developed at least one post-operative complication. Wound sepsis was the most frequently observed complication (20.2%) followed by electrolyte imbalance (9.2%). Post-operative mortality occurred in 19.0% (31/163 patients). Advanced age, higher ASA scale and intra-operative complication were strongly associated with increased risk of mortality. Electrolyte imbalance, chest infection and postoperative shock were closely associated with post-operation mortality. Conclusions: Common short-term postoperative complications were wound sepsis, electrolyte imbalance and chest infection. The predictors of postoperative mortality were; patients aged above 60 years, high ASA score and occurrence of intra-operative complications. Emergency abdominal surgeries contributed to prolonged hospitalization.
Key words: High-risk abdominal Surgery, Advanced age, Intra-operative complications, Co-morbidity, ASA scale, Short-term Postoperative outcomes, predictors of outcomes |
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