EMERGENCY SURGICAL SERVICES; A CROSS-SECTIONAL STUDY OF DELAYS AND ASSOCIATED MORBIDITY AND MORTALITY AT MNRH.

Abstract

Background: Delayed time to offer emergency surgical services is associated with increased morbidity and mortality. Surgical emergency is the largest burden of disease in surgery. It has been noted that the provision of timely treatment during life-threatening emergencies is not a priority for many health systems in developing countries. Surgical emergencies are timebound; surgical intervention can be lifesaving or organ/limb saving meaning they should be carried out within minutes of the decision to intervene. However, due to multifactorial delays, these emergency surgical interventions turn into expedited interventions. Multiple studies show delays are experienced in both developed and developing countries. And the factors associated with delays are multifactorial; patient factors, health worker factors, facility factors, and system factors. Delays in providing emergency surgical services in our setting are not well studied and documented. Delayed time to provide emergency surgical services can be used as one of the key performance indicators of quality of care of a health facility. This study, therefore, seeks to highlight some of these factors, hence inform practice, providing information on the magnitude of surgical sequelae following these delays. Objective: To describe factors causing delays in the management of surgical emergencies in MNRH A&E department and determine 72 hours’ morbidity and mortality. Methods: A cross-sectional descriptive study of 316 participants. The study population included all patients with the surgical emergency condition who attended MNRH A&E Department during the study period. Significance: The findings of this study informed us of the magnitude of the problem in MNRH. Quantifying these factors will help improve the quality of service offered and acts as one of the key performance indicators for the stakeholders to make decisions from an informed point of view. It provides feedback to the health service providers to assess their performance at the departmental level. It further provides a source of record for the hospital and surgery department for future reference. Results: In 64.7% of patients experienced delays with an average mean time of 12.10hrs. With time for review having most delays 77.5% and time to intervention following review experiencing 42.7% of delays. Associated factors of delays; lack of medical supplies 87.7%, delayed investigation results 86.5%, financial constraints 83.5%, unavailability of personnel 78%; surgeon being the cadre most affected. The majority of patients had moderate (31.3%) to severe (29.1%) complications and 5.7 % having death as an outcome.