Prise en Charge des Appendicites Compliquées de l’Adulte à l’Hôpital National de Niamey

            Objectif : rapporter les résultats de la prise en charge des appendicites compliquées chez l’adulte à l’Hôpital National de Niamey (HNN).   Résultats : Pendant  la période de l’étude 8127 urgences abdominales avaient été enregistrées dont 1837 d’origine appendiculaire, parmi lesquelles  512 étaient des appendicites compliquées, soit 6,3 % des urgences abdominales et 27,9 % de toutes les pathologies appendiculaires. Il s’agissait de 337 (65,8 %) hommes et 175 (34,2 %) femmes ; soit un sex ratio de 1,9. L’âge médian des patients était de 30 ans, avec 75% de patients d’âge inférieur ou égal à 40 ans (3è quartile=40 ans) ainsi que des extrêmes allant de 16 ans et de 90 ans. Le délai d’admission  médian était   de 5 jours (Q1=3, Q3=7) avec un taux de 49,6 %(n=254) de patients  admis après 48 heures. Les appendicites compliquées retrouvées étaient la péritonite appendiculaire dans 74 % des cas (n=379) suivie de l’abcès appendiculaire dans 21,5 % des cas (n=110) et du plastron appendiculaire dans 4,5%(n=23) des cas. La chirurgie était pratiquée dans  95,5% des cas (n = 489). La voie d’abord utilisée était la laparotomie médiane sus et sous ombilicale dans 81 % des cas (n=415) et l’incision de Mac Burney dans 14,5%(n=74). L’appendice était gangréné dans 95,7 % des cas (n=490) à l’exploration. Le geste  réalisé était l’appendicectomie dans 89,9 % des cas (n= 460).  L’étude rapporte que 93,3%(n=478) des patients avaient un séjour total (pré et postopératoire)  ≤ 10 jours avec des extrêmes allant d’un jour et de 76 jours d’hospitalisation. La morbimortalité globale était de 11,5 %(n= 59). La suppuration pariétale était retrouvée dans 10 % des cas (n= 51). La  mortalité  était de 1,5 % (n = 8) tous enregistrés parmi les cas de péritonite appendiculaire. Le séjour hospitalier total (initial et post-appendicectomie) variait de un(1) jour à 76 jours ; 93,36%(n=478) avaient un séjour ≤ 10 jours. La médiane de séjour hospitalier était de 14,5 jours ; 75% des patients passaient moins de 28 jours en hospitalisation (3è quartile=28 jours).  Conclusion : Les appendicites compliquées sont fréquentes à l’HNN avec une morbimortalité importante. Le retard de la prise en charge constitue un facteur influencant la survenue des complications.                 Objective : To report the results of the management of complicated appendicitis in adults at the National Hospital of Niamey (HNN). Patients and method: This was a 10-year retrospective, descriptive, and analytical study including all patients over 15 years of age who had been managed for complicated appendicitis at HNN. Results: During the study period, 8127 abdominal emergencies were recorded, of which 1837 were of appendicular origin, of which 512 were complicated appendicitis, i.e. 6.3% of abdominal emergencies and 27.9% of all appendicular pathologies. These were 337 (65.8%) men and 175 (34.2%) women; i.e. a sex ratio of 1.9. The median age of patients was 30 years, with 75% of patients less than or equal to 40 years of age (3rd quartile=40 years) as well as extremes ranging from 16 years to 90 years. The median time to admission was 5 days (Q1=3, Q3=7) with a rate of 49.6% (n=254) of patients admitted after 48 hours. Complicated appendicitis was appendicular peritonitis in 74% of cases (n=379) followed by appendicular abscess in 21.5% of cases (n=110) and appendicular plastron in 4.5% (n=23) of cases. Surgery was performed in 95.5% of cases (n = 489). The approach used was median laparotomy above and subumbilical laparotomy in 81% of cases (n=415) and Mac Burney incision in 14.5% (n=74). The appendix was gangrenous in 95.7% of cases (n=490) on exploration. Appendectomy was performed in 89.9% of cases (n=460).  The study reports that 93.3% (n=478) of patients had a total stay (pre and postoperative) ≤ 10 days with extremes ranging from one day and 76 days of hospitalization. Overall morbidity mortality was 11.5% (n=59). Parietal suppuration was found in 10% of cases (n=51). Mortality was 1.5% (n=8), all recorded among cases of appendicular peritonitis. Conclusion: Complicated appendicitis is common at NNH with significant morbidity mortality. Delayed treatment is a factor influencing the occurrence of complications.&nbsp

Anaesthetic Management of Homozygous Sickle Cell Patients at Niamey National Hospital, Niger

Background: Sickle cell disease is a common comorbidity in patient presenting for surgical care in our hospitals. The aim of this study was to evaluate the outcome of anaesthetic management of sickle cell disease patients in our hospital.Patients and method: A prospective audit was conducted for a period of 12 months, from 1st March 2015 to 29th February, 2016. Included were all homozygous sickle cell patients who underwent anaesthesia. The following variables were studied: age, sex, blood transfusion, hemoglobin level, ASA status, type of anaesthesia, pre-, intra- and post-operative management and outcome.Results: Thirty (30) patients with homozygous sickle-cell disease were found among the 3882 patients who were operated on (0.77%). Mean age was 12 ± 8 years, with a range from 9 months to 36 years. More than half of the patients were female (53.3%) with a sex ratio of 1.14. Hemoglobin level was less than 7 g / dl in 23.33%. Only 6.67% of patients had hemoglobin level above 10 g / dl. Of the 30 patients, 93.34% were ASA II, 36.70% had preoperative transfusion, surgery was elective in 93.30% and emergent in 6.70%. The commonest surgical procedures were tonsillectomy in 26.66%. General anaesthesia was performed in 96.70% of patients, spinal anaesthesia in 3.30%. Intraoperative incidents occurred in 23.33%. Intraoperative transfusion was given to 43.30% of patients. Mortality rate was 10%.Conclusion: Anaesthetic management of the sickle cell patient in our hospital is challenging due to lack of transfusion procedures and exchange transfusions.Keywords: Sickle cell disease, anaesthesia, outcome, Niamey, Nige

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran