Prevalence and factors associated with pre-operative delays among neurotraumatic patients at Mulago National Referral Hospital: a cross-sectional study

Abstract

Introduction Neurotraumatic emergencies affect more than 10 million people globally with majority of them from sub-Saharan. Neurotraumatic emergencies present a challenge in emergency surgical care, demanding quick and precise intervention to mitigate potentially life-threatening outcomes. Despite this there are still preoperative delays for these patients. Study Objective; To determine the prevalence and factors associated with pre-operative delays among neurotraumatic patients requiring surgery at Mulago National Referral Hospital. Methods: This was a descriptive cross-sectional study, and the participants were recruited through consecutive sampling. An interviewer administered questionnaire was used to collect data on prevalence and factors associated with preoperative delays. Preoperative delay was defined as the time exceeding six hours (> 6 hours) from the decision to operate to the initiation of surgery and measured as a binary outcome (categorized as either delayed or not delayed). Modified Poisson regression was used to determine independent factors associated with preoperative delays. Results: A total of 184 participants were recruited into the study. The median age of the participants was 33.5 years (IQR, 24-50), 162 (88%) were male. Majority 111(60.3%) of the participants had mild head injury whereas RTA contributed to majority of the injuries at 100 (54.3%). Majority 158 (85.9%) of the participants reported lack of anaesthetic drugs/equipment. The prevalence of pre-operative delays was 90.2% (95%CI,84.9-93.8). The patient related factors associated with pre-operative delays were the GCS score (aRR, 1.02; 95%CI,1.01-1.04; P=0.014) and being unknown patient (aRR, 1.15; 95%CI CI,1.04-1.28; P=0.006). The health system related factors were lack of anaesthetic drugs (aRR, 1.39; 95%CI,1.08-1.81; P=0.011) and lack of theatre space (aRR, 1.09; 95%CI,1.02-1.18; P=0.02). Conclusion: The prevalence of pre-operative delays among neurotraumatic patients at MNRH is high at 90.2%. The patient related factors associated with pre-operative delays were a high GCS score and being an unknown patient whereas the health system related factors associated with pre-operative delays were lack of anaesthetic drugs and lack of theatre space