IMPACT OF TIME-TO-SURGERY ON OUTCOMES IN ACUTE ABDOMEN: A PROSPECTIVE OBSERVATIONAL STUDY FROM A BUSY EMERGENCY UNIT

Abstract

Objective: To determine the impact of time-to-surgery on postoperative outcomes in patients presenting with acute abdomen requiring emergency laparotomy.

Background: Acute abdomen is a very common surgical emergency in the world and a huge spectrum of lethal intraabdominal pathology necessitating immediate surgery. The time interval from presentation to hospital to skin incision is a potentially modifiable determinant of surgical outcome that we are calling time-to-surgery. It is well established that delayed operative intervention, progression of disease allows worsening peritoneal contamination, systemic inflammatory response and a significant increase in postoperative morbidity and mortality. Despite this, in low resource situations there are often many reasons for symptoms to remain latent until arrival and time-to-surgery is often extended, due to delays in diagnosis, overcrowded emergency departments and operating theatre availability and sub-optimal triage protocols.

Place of study and Duration: Hayatabad Medical Complex (HMC) Peshawar in Emergency Surgical Unit.

Methodology: This prospective observational study enrolled  120 adult patients with acute abdomen were chosen who had emergency laparotomy an intervention that was performed in the prospective manner. Patients were divided in the following groups: Early surgery group (≤6 hours after presentation, n=54), and Delayed surgery group (>6 hours after presentation, n=66). Primary outcomes were the relative frequency of surgical site abscess, anastomotic leak, wound infection, 30-day mortality and admission to a critical care unit. Hospital stay was also compared in terms of mean stay. Analysis of the data was carried out on SPSS version 25.0.

Results: The mean age was 38.6 ± 14.2 years with male predominance (65.0%). The most frequent aetiology was acute appendicitis (35.0%), hollow viscus perforation (28.3%) and intestinal obstruction (22.5%). Wound infection (14.8% vs 36.4%), anastomotic leak (5.6% vs 15.2%), ICU admission (11.1% vs 31.8%) and 30-day mortality (3.7% vs 13.6%) were all significantly lower in the early surgery group (all p<0.05). In-hospital stay (ITS) was significantly shorter in the early surgery group than in the late surgery group (5.8 ± 2.1 vs 9.4 ± 3.6 days; p<0.001).

Conclusion: in early surgical intervention (ESI) significantly reduced the risk of wound infection, anastomotic leak, ICU admission and death in patients with AWB presented within 6 hours. Time-to-surgical access and time-to-surgical theatre is one of the most effective and practisable plans that can be implemented in HMC Peshawar and other high volume facilities for better outcomes in emergency surgery.