Postoperative Complications in Emergency Surgeries at a Referral Hospital in Eastern Venezuela

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Abstract

Background

Postoperative complications (POC) are undesirable consequences of surgery and are a major area of concern adversely affecting the quality of surgical care and patient safety. Emergency surgery has been observed to have a higher incidence of different POC. The analysis of POC is of great importance due to their impact on the quality of life of patients and because they have become an indicator to measure the quality of hospital services.

Objective

This study aimed to describe the POC of emergency surgeries in patients from the general surgery department of a referral hospital in eastern Venezuela.

Methodology

A cross-sectional retrospective study was conducted, including patients undergoing emergency surgery at "Dr. Luis Razetti" University Hospital, Barcelona, Venezuela, between November 2022 and May 2023.

Results

Medical records of 178 patients were analyzed. Most were male (53.7%), with an average age of 34.98 and a standard deviation of 18.2 years. POC was registered in 28 (15.7%) patients, with surgical site infection being the most common in 21 (39.62%) patients. Those over 65 years old (21.4% vs. 6.4%, p=0.013), patients with a history of hypertension (25% vs. 6.3%, p=0.002), hypoalbuminemia (100% vs. 43.8%, p=0.027), diagnosed with peritonitis due to hollow viscus perforation (21.4% vs. 6%, p=0.007), trauma (25% vs. 9.3%, p=0.018), and those with a midline incision (75% vs. 31.3%, p<0.001) had a higher frequency of POC. There was a mortality rate of 2.8% with no significant difference based on the development of POC.

Conclusion

POC represents a significant cause of morbidity and mortality in patients undergoing emergency surgeries. The studied sample showed a similar frequency of POC compared to previous reports but with lower mortality. Complications were associated with higher frequencies of hypertension, midline approach, hypoalbuminemia, and emergency surgery for peritonitis due to hollow viscus perforation and trauma.

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Most cited references 22

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Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging?

M Cappellini, Irene Motta (2015)

Anemia is a global public health problem affecting both developing and developed countries at all ages. According to the World Health Organization (WHO), anemia is defined as hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men. However, normal Hb distribution varies not only with sex but also with ethnicity and physiological status. New lower limits of normal Hb values have been proposed, according to ethnicity, gender, and age. Anemia is often multifactorial and is not an independent phenomenon. For the classification and diagnosis the hematologic parameters, the underlying pathological mechanism and patient history should be taken into account. The aging of population, especially in Western countries, causes an increase of anemia in elderly people. In this population, anemia, recently defined by levels of Hb <12 g/dL in both sexes, is mostly of mild degree (10-12 g/dL). Understanding the pathophysiology of anemia in this population is important because it contributes to morbidity and mortality. In one third of the patients, anemia is due to nutritional deficiency, including iron, folate, or vitamin B12 deficiency; moreover, anemia of chronic disease accounts for about another third of the cases. However, in one third of patients anemia cannot be explained by an underlying disease or by a specific pathological process, and for this reason it is defined "unexplained anemia". Unexplained anemia might be due to the progressive resistance of bone marrow erythroid progenitors to erythropoietin, and a chronic subclinical pro-inflammatory state.

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Risk Associated With Complications and Mortality After Urgent Surgery vs Elective and Emergency Surgery: Implications for Defining "Quality" and Reporting Outcomes for Urgent Surgery.

Matthew Mullen, Alex Michaels, J Mehaffey … (2017)

Given the current climate of outcomes-driven quality reporting, it is critical to appropriately risk stratify patients using standardized metrics.

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Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis.

Daniel T. Bainbridge, Davy Cheng, Janet Martin … (2012)

The magnitude of risk of death related to surgery and anaesthesia is not well understood. We aimed to assess whether the risk of perioperative and anaesthetic-related mortality has decreased over the past five decades and whether rates of decline have been comparable in developed and developing countries. We did a systematic review to identify all studies published up to February, 2011, in any language, with a sample size of over 3000 that reported perioperative mortality across a mixed surgical population who had undergone general anaesthesia. Using standard forms, two authors independently identified studies for inclusion and extracted information on rates of anaesthetic-related mortality, perioperative mortality, cardiac arrest, American Society of Anesthesiologists (ASA) physical status, geographic location, human development index (HDI), and year. The primary outcome was anaesthetic sole mortality. Secondary outcomes were anaesthetic contributory mortality, total perioperative mortality, and cardiac arrest. Meta-regression was done to ascertain weighted event rates for the outcomes. 87 studies met the inclusion criteria, within which there were more than 21·4 million anaesthetic administrations given to patients undergoing general anaesthesia for surgery. Mortality solely attributable to anaesthesia declined over time, from 357 per million (95% CI 324-394) before the 1970s to 52 per million (42-64) in the 1970s-80s, and 34 per million (29-39) in the 1990s-2000s (p<0·00001). Total perioperative mortality decreased over time, from 10,603 per million (95% CI 10,423-10,784) before the 1970s, to 4533 per million (4405-4664) in the 1970s-80s, and 1176 per million (1148-1205) in the 1990s-2000s (p<0·0001). Meta-regression showed a significant relation between risk of perioperative and anaesthetic-related mortality and HDI (all p<0·00001). Baseline risk status of patients who presented for surgery as shown by the ASA score increased over the decades (p<0·0001). Despite increasing patient baseline risk, perioperative mortality has declined significantly over the past 50 years, with the greatest decline in developed countries. Global priority should be given to reducing total perioperative and anaesthetic-related mortality by evidence-based best practice in developing countries. University of Western Ontario. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 7 May 2024

Publication date (Electronic, collection): May 2024

Volume: 16

Issue: 5

Electronic Location Identifier: e59805

Affiliations

[1 ] Department of Surgery, Universidad de Oriente, Nucleo Anzoategui, Barcelona, VEN

[2 ] Department of Surgery, Hospital Leon Becerra Camacho, Milagro, ECU

[3 ] Department of Surgery, Universidad de Cuenca, Cuenca, ECU

[4 ] Department of Surgery, Universidad Iberoamericana, Santo Domingo, DOM

[5 ] Department of Surgery, Universidad Católica de Santiago de Guayaquil, Guayaquil, ECU

[6 ] Department of Surgery, Instituto Tecnológico de Santo Domingo, Santo Domingo, DOM

[7 ] Department of Surgery, Universidad Del Rosario, Bogota, COL

[8 ] Department of Surgery, Ministerio de Salud Pública, Hospital Esmeraldas sur Delfina Torres de Concha, Quito, ECU

Author notes

Yeisson Rivero-Moreno yeissonmbi@ 123456gmail.com

Article

DOI: 10.7759/cureus.59805

PMC ID: 11154079

PubMed ID: 38846234

SO-VID: 54e6501c-d951-4a26-85b2-8b57763d0d07

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date accepted : 7 May 2024

Postoperative Complications in Emergency Surgeries at a Referral Hospital in Eastern Venezuela

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Most cited references 22

Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging?

Risk Associated With Complications and Mortality After Urgent Surgery vs Elective and Emergency Surgery: Implications for Defining "Quality" and Reporting Outcomes for Urgent Surgery.

Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis.

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