ABSTRACT
BACKGROUND: The perioperative mortality rate is an indicator of access to safe anesthesia and surgery. Studies showed higher perioperative mortality rates among low- and middle-income countries. But the specific causes and factors contributing to perioperative death have not been adequately studied in the Ethiopian context. METHODS: This is a retrospective institutional study of the largest academic medical center in Ethiopia. Data of all patients who were admitted to surgical wards or intensive care and underwent surgical interventions were evaluated for perioperative mortality rate determination. All mortality cases were then evaluated in depth. RESULTS: Of the 3295 patients evaluated, a total of 148 patients (4.5%) died within 30 days of surgery. By the 7th postoperative day, 69.5% of the perioperative mortality had already occurred. Septic shock contributed to 54.2% of deaths. Emergency surgery patients had more than a twofold higher mortality rate than elective surgery patients (p value < 0.001) and had a 2.6-fold higher rate of dying within 7 days of surgery (p value of 0.02). Patients with ASA performance status of 3 or more had a 1.7-fold higher rate of death within 72 h of surgery (p value of 0.015). CONCLUSION: More than two thirds of patients died within 7 postoperative days. More emergency patients died than elective counterparts, and emergency cases had a higher rate of dying within 7 days of surgery. Poor ASA performance score was associated with earlier postoperative death. Further prospective multi-institutional studies are warranted to elucidate the factors that contribute to higher postoperative mortality in low-income country patients.
ABSTRACT
Background: Alvarado score is the most widely used scoring system for diagnosing acute appendicitis, globally. There have been concerns regarding the diagnostic accuracy of this score as it was shown to have lower sensitivity in certain populations like Blacks and Asians. Despite its wide clinical use in the Ethiopian set up, the diagnostic accuracy of this score remained largely unexamined in this population. Methodology: A prospective cross-sectional study was conducted and all adult patients who presented with right lower quadrant abdominal pain and evaluated with a clinical impression of acute appendicitis were enrolled in the study. Data was collected by trained surgical residents over a period of six months (August 2019- January 2020) and analysed using SPSS version 25. Results: A total of 235 patients were enrolled in this study among whom two thirds were males. The majority of the study participants (61.7%) had an Alvarado score of ≥7 while almost a quarter of them had a score of <4. The mean Alvarado score in this study was 7 ± 1.8 whereas the median and the mode were 7 and 9 respectively. The overall sensitivity, specificity, positive predictive value and negative predictive value of Alvarado score were 99.1%, 55.6%, 98.2% and 62.5% respectively. The sensitivity and specificity of this score was superior in males compared to females (99.3% vs 97.6% and 80% vs 25%). A score of ≥5 was found to have a sensitivity of 98.4%. Conclusion: Alvarado score was found to have good sensitivity and positive predictive value in this study. A score of ≥5 can be used to "rule in" the diagnosis of acute appendicitis. Hence, the use of Alvarado score's in the Ethiopian setup is to be encouraged.
ABSTRACT
Background: Mean aortic and common iliac artery diameters are the best indicators for the diagnosis of aortic and iliac ectasia and aneurysm, as well as the appropriate selection of angiographic catheter size and grafts for endovascular procedures. Currently, there is a lack of evidence regarding the normal abdominal aortic and common iliac artery diameters in Ethiopian adults. This study aimed to assess the mean diameter and associated factors of the abdominal aorta and common iliac arteries on abdominal CT scans of Ethiopian adults visiting Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: Institution-based prospective cross-sectional study was conducted. A convenience sampling method was employed. Data were collected from consecutive eligible adults who came for abdominal CT scans during the study period, using interviewer-administered structured questionnaires. The data was cleaned and analyzed using SPSS version 22. Student t-test and Pearson correlation were used to perform statistical analysis and the results were presented using tables and figures. Results: There were a total of 136 study participants of whom eighty-one(59.6%) were females and fifty-five (40.4%) were males. The mean age was 48.5 ± 13 with a range of 23 to77 years. The mean transverse diameter of the aorta at the aortic hiatus (T12)level was 2.30 ± 0.25cm in males and 2.03±0.19cm in females. The mean transverse diameter of the suprarenal aorta was 2.04 ± 0.21cm in males and 1.83 ± 0.21 cm in females while the infrarenal one was 1.77 ± 0.16cm in males and 1.54 ± 0.15cm in females. Participants who are male and older with large body Surface Area were found to have relatively larger aortic and iliac diameters. Conclusion: In this study, the mean diameter of the aorta and common iliac artery was significantly associated with age, sex, and BSA.
