Post-operative pulmonary complications after thoracic and upper abdominal procedures at referral hospitals in Amhara region, Ethiopia: a multi-center study.

Background: Thoraco-abdominal surgery cuts through muscle, disrupting the normal structure and function of the respiratory muscles, resulting in lower lung volumes and a higher risk of developing post-operative pulmonary complications (PPC). PPC remains an important cause of post-operative morbidity and mortality and impacts the long-term outcomes of patients after hospital discharge. This study was aimed at determining the incidence and factors associated with postoperative pulmonary complications among patients who underwent thoracic and upper abdominal surgery in the Amhara region of Ethiopia. Methods: A multi-center follow-up study was conducted from April 1, 2022, to June 30, 2022, at comprehensive specialized hospitals in Amhara regional state, northwest Ethiopia. 424 patients were consecutively included in this study, with a response rate of 100%. A chart review and patient interview were used to collect data. A logistic regression analysis was performed to assess the strength of the association of independent variables with postoperative pulmonary complications.The crude odds ratio (COR) and adjusted odds ratio (AOR) with the corresponding 95% confidence interval were computed. Variables with a p-value of <0.05 were considered statistically significant predictors of the outcome variable. Results: The incidence of postoperative pulmonary complication was 24.5%. Emergency procedures, preoperative SpO2 < 94%, duration of surgery >2 h, patients with a nasogastric tube, intraoperative blood loss >500 ml and post-operative albumin <3.5 g/dl were factors associated with pulmonary complications. The most common complications were pneumonia (9.9%) followed by respiratory infection (4.2%). Conclusion: The incidence of postoperative pulmonary complication after thoracic and upper abdominal surgery remains high. Preoperative SpO2, duration of surgery, patients having a nasogastric tube, intraoperative blood loss and post-operative albumin were factors associated with post-operative pulmonary complications.

Magnitude and associated non-clinical factors of delayed discharge of patients from post-anesthesia care unit in a comprehensive specialized referral hospital in Ethiopia, 2022.

Background: Patients are kept in the post anesthesia care unit until their condition is stabilized before transfer to the clinical areas. Prolonged length of stay in the PACU leads to increased health care cost and patient dissatisfaction. Objective: The aim of this study was to determine the magnitude and to identify the non-clinical factors that lead to delay discharge from the post anesthesia care unit. Method: This prospective observational study was conducted from April 1, 2022 to June 5, 2022. Patients were considered ready for discharge after they had achieved a satisfactory discharge score. The data obtained were presented as descriptive statistic and were analyzed using SPSS version 20. Results: A total of 307 patients admitted to in the post anesthesia care were included in this study with a response rate of 100%. Majority of patients, 188 (61.2%), had prolonged length of stay in the PACU because of non-clinical factors. The most common non-clinical factor for delayed discharge was unavailability of beds in the respective ward (n = 69, 22.5%) followed by lack of available hospital patient transport (n = 34, 11.1%). Conclusion: and recommendations: The proportion of delayed discharge of patients from the post anesthesia care unit (PACU) was significant. Non-clinical related delays contributed for a considerable extension of a patient's time in PACU. Delay discharge for non-medical reasons put patients at unnecessary risk for hospital-acquired infections and prolonged hospital stay and increased health care costs. Thus, understanding and addressing the causes of delayed discharge from PACU is essential.

Preoperative investigations for elective surgical patients in a resource limited setting: Systematic review.

Background: Preoperative investigation for surgical patients is important to check for conditions that may affect surgical outcome. It helps the anesthetist and surgeon to plan perioperative anesthesia and surgical management appropriately. However, 60-70% of laboratory tests before surgery are not really required. This review was conducted to develop evidence-based recommendations on preoperative investigations for patients waiting for surgery in a resource limited setting. Methods: After formulating the key questions, scope, and eligibility criteria for the articles to be included, advanced search strategy of electronic sources from data bases and websites was conducted. Duplication of literatures was avoided by endnote. Screening of literatures was conducted with proper appraisal. This review was reported in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) 2020 statement. Results: A total of 553 articles were identified from data bases and websites using an electronic search. 75 articles were removed for duplication and 223 studies were excluded after reviewing titles and abstracts. At the screening stage, 82 articles were retrieved and evaluated for eligibility. Finally, 46 studies met the eligibility criteria and were included in this systematic review. Conclusion: and recommendation: Selective laboratory ordering reduces the number and cost of investigations. Preoperative tests should be guided by the patient's clinical history, co-morbidities, and physical examination. Patients with signs or symptoms of certain types of disease should be evaluated with appropriate testing. Therefore, adherence to recommendations of guidelines on preoperative investigation is important for good surgical outcome and patient satisfaction.