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Early Outcome of Laparotomy Wounds in Pediatric Patients in TASH, Addis Ababa, Ethiopia: A Six-Months Prospective
Fisseha Temesgen1, Abay Gosaye1, Nichole Starr2
1Addis Ababa University, Tikur Anbessa Specialized Hospital, Department of Surgery, Zambia St., Addis Ababa, Ethiopia.
Insights
Surgical site infections and wound dehiscence are common in pediatric laparotomy patients in Ethiopia. Key risk factors include delayed antibiotics and longer operative times, highlighting areas for improved surgical care.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Surgical Outcomes Research
Background:
- Surgical Site Infection (SSI) and wound dehiscence are significant early complications following laparotomy.
- These complications contribute to increased morbidity and mortality in pediatric surgical patients.
- Understanding prevalence and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the prevalence of SSI and wound dehiscence in pediatric surgical patients undergoing laparotomy.
- To identify independent risk factors associated with SSI and wound dehiscence in this population.
- To explore the impact of SSI on other postoperative outcomes, including hospital stay and mortality.
Main Methods:
- Prospective observational study conducted at Tikur Anbessa Specialized Hospital, Ethiopia.
- Data collected on demographics, operative details, nutritional status, antibiotic administration, and outcomes.
- Statistical analysis included Fisher's exact, Chi-squared tests, and multivariable logistic regression.
Main Results:
- Overall SSI rate was 21.05%; wound dehiscence occurred in 7.9% of patients.
- Independent risk factors for SSI included delayed prophylactic antibiotics, longer operative duration, and wound class.
- SSI independently predicted prolonged hospital stay and increased risk of wound dehiscence.
Conclusions:
- SSI and wound dehiscence are prevalent in the studied pediatric surgical population.
- Prophylactic antibiotic timing, operative duration, and wound contamination are key predictors of SSI.
- Age and malnutrition were significantly associated with wound dehiscence, emphasizing the need for targeted interventions.
Background:
Surgical Site Infection (SSI) and wound dehiscence are two early complications of laparotomy causing significant morbidity and mortality. This study was conducted to determine the prevalence and risk factors of SSI and wound dehiscence in pediatric surgical patients.
Methods:
We performed a prospective observational study of all pediatric surgical patients who underwent laparotomy at Tikur Anbessa Specialized Hospital, Ethiopia, from December 2017 to May 2018. Data collected included demographics, operative indication, nutritional status, prophylactic antibiotics administration, and duration of operation. Primary outcome was SSI; secondary outcomes were hospital stay and other postoperative complications, including wound dehiscence and mortality. Data were analyzed using SPSS, Version 23. Fisher's exact and Chi-squared tests used to report outcomes. Multivariable logistic regression was used to identify variables associated with SSI, wound dehiscence and other outcomes.
Results:
Of 114 patients, median age was 46 months [range: 1day-13 years]; 77(67.5 %) were males. Overall SSI rate was 21.05%. Nine (7.9%) developed wound dehiscence while 3(2.6%) had abdominal contents evisceration. Overall mortality rate was 2.6%. In multivariate analysis, prophylactic antibiotics administration (AOR=13.05, (p=0.006)), duration of procedure (AOR=8.62, (p=0.012)) and wound class (AOR=16.63, (p=0.034)) were independent risk factors for SSI while SSI was an independent predictor of prolonged hospital stay, >1 week (AOR=4.7, p=.003,) and of wound dehiscence (AOR=33. 96, p=0.003). Age (p=0.004) and malnutrition (p<0.001) were significantly associated with wound dehiscence.
Conclusion:
SSI and wound dehiscence are common in this setting. Wound contamination, antibiotics administration >1 hour before surgery and operative time >2 hours are independent predictors of SSI.
