The Postoperative Complications Prediction in Mulago Hospital using POSSUM Scoring System

Introduction: Prediction of complications is an essential part of risk management in surgery. Knowing which patient to operate and those at high risk of developing complications contributes significantly to the quality of surgical care and cost reduction. The postoperative complications of patients who underwent Laparotomy in Mulago hospital were studied using POSSUM scoring system. The main objective of this study was to determine the postoperative complications of Laparotomy in Mulago Hospital; between September 2003 and February 2004. Methods: consecutive patients; who underwent Laparotomy in Mulago; were studied using POSSUM system for development of complications. For each patient operated; they were followed up in wards until discharge. When the postoperative complications were reported; they were reexamined by the surgeons; treated and followed up for 30 days postoperatively. Phone contacts were used for the follow up. Surgical reviews were conducted once a week in Mulago Hospital and the data obtained recorded in the data sheet for the patients. Results: Seventy-six patients were studied. The observed post operative complications were as follows: Respiratory tract infection (28.2); wound haemmorrhage (18.2); anaemia (15.5); hypotension (14.1); UTI (2.2); Anastomotic leak (1.4); Wound sepsis (9.9); wound dehiscence (4.2); Thromboembolism (1.4). The postoperative nursing care significantly determined the outcomes. Conclusion: Postoperative complications can be predicted in the modern management of surgery especially while using a scoring system

Clinical Presentation and Outcome of Neurosurgical Conditions at Butare Teaching Hospital; Rwanda

Background: Neurosurgical services have only been introduced in Rwanda recently. Consequently little information about spectrum of neurosurgical conditions in th country is available. This descriptive prospective study was aimed at determining the pattern; causes and outcome of management of neurosurgical conditions seen in Butare University Teaching Hospital (BUTH) in Rwanda. Methods: The study population consisted of 152 patients admitted at BUTH with neurosurgical conditions between October 1 2007 and May 31 2008. Patients were grouped into different neurosurgical conditions according to their clinical presentations. . Information collected included age; gender; cause and severity of injury; the time interval between injury Glasgow Coma Score; GOS scales were used to assess head injured patients. Results: The majority (70.4) of patients came from rural areas. Their ages ranged from 15 days to 78 years with a mean of 31.98+/-18.75 years. The Male to female sex ratio was 2:1. Most (73.0) of the patients suffered from trauma with 67.6of them sustaining head injury and 32.4; spinal trauma. Motor Vehicle crashes were the major cause of traumatic injuries (20in spinal trauma and 70.7of head trauma). Only 23of the patients had CT scan performed. Only 12of patients with traumatic brain injury (TBI) had CT scan.. A total of 78.7of all head injuries were admitted in the first 24 hours following trauma. A significant number (44.4) of spinal cord injury presented late (up to 7 days before referral to a neurosurgeon) and stayed longer in the hospital (52.7up to 3 months). Laminectomy and fixation was the most common spinal operative procedure (58.7) followed by discectomy (34.8). The commonest cranial operation was for posttraumatic intracranial haemorrhage (41.4) followed by surgery for depressed fracture (37.9). One child had a shunt procedure for hydrocephalus. Good recovery was associated with GCS 13 on admission (P0.001). The overall mortality rate was 13.2. The mortality among patients admitted with GCS 8 was 52.4. Conclusion: Neurological injuries were the most commonly seen conditions mainly in head injuries. This study confirms that neurosurgical procedures can still be done with fair results using very little equipment. Providing basic equipment to national neurosurgeons; however; and training them to work in an adverse environment remains a big challenge