Perioperative serum albumin as a predictor of adverse outcomes in abdominal surgery: prospective cohort hospital based study in Northern Tanzania

BACKGROUND: Albumin is an important protein that transports hormones, fatty acids, and exogenous drugs; it also maintains plasma oncotic pressure. Albumin is considered a negative active phase protein because it decreases during injuries and sepsis. In spite of other factors predicting surgical outcomes, the effect of pre and postoperative serum albumin to surgical complications can be assessed by calculating the percentage decrease in albumin (delta albumin). This study aimed to explore perioperative serum albumin as a predictor of adverse outcomes in major abdominal surgeries. METHODS: All eligible adult participants from Kilimanjaro Christian Medical Centre Surgical Department were enrolled in a convenient manner. Data were collected using a study questionnaire. Full Blood Count (FBP), serum albumin levels preoperatively and on postoperative day 1 were measured in accordance with Laboratory Standard Operating Procedures (SOP). Data was entered and analyzed using STATA version 14. Association and extent of decrease in albumin levels as a predictor of surgical site infection (SSI), delayed wound healing and death within 30 days of surgery was determined using ordinal logistic regression models. In determining the diagnostic accuracy, a Non-parametric Receiver Operating Curve (ROC) model was used. We adjusted for ASA classification, which had a negative confounding effect on the predictive power of the percent drop in albumin to adverse outcomes. RESULTS: Sixty one participants were studied; the mean age was 51.6 (SD16.3), the majorities were males 40 (65.6%) and post-operative adverse outcomes were experienced by 28 (45.9%) participants. In preoperative serum albumin values, 40 (67.8%) had lower than 3.4 g/l while 51 (91%) had postoperative albumin values lower than 3.4 g/l. Only 15 (27.3%) had high delta albumin with the median percentage value of 14.77%. Delta albumin was an independent significant factor associated with adverse outcome (OR: 6.68; 95% CI: 1.59, 28.09); with a good predictive power and area under ROC curve (AUC) of 0.72 (95% CI 0.55 0.89). The best cutoff value was 11.61% with a sensitivity of 76.92% and specificity of 51.72%. CONCLUSION: Early perioperative decreases in serum albumin levels may be a good, simple and cost effective tool to predict adverse outcomes in major abdominal surgeries

Otorhinolaryngology Services at Muhimbili National Hospital and Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania

Background: Epistaxis is the commonest ear, nose and throat emergency. It's mostly self-limited but it may be severe such that medical attention is sought and in such cases it may be life threatening. There is paucity of data on the prevalence and management options for epistaxis in Tanzania and at Muhimbili National Hospital (MNH) and Muhimbili Orthopedic Institute (MOI), no any published study has unveiled it despite being the commonly encountered emergency in our department. The aim of this study was thus to determine the prevalence, aetiology and treatment modalities of epistaxis among patients receiving otorhinolaryngology services at MNH and MOI.Materials and Methods: A cross-sectional, hospital based study was done to 427 patients at Muhimbili National Hospital (MNH) and Muhimbili Orthopedic Institute (MOI). Data was collected using structured questionnaires from June to December 2015 and it was then analyzed using SPSS program.Results: A total of 427 patients aged 1-82 years were recruited with majority of the patients being females (54.6%). The mean age at diagnosis was found to be 27±23 years.The prevalence of epistaxis was found to be lower among patients below 20 years (12.5%) of age and higher among patients over the age of 40years (34.9%). Prevalence of epistaxis was found to be higher among males (29.9%) compared to females (18 %). Majority of patients had anterior epistaxis (73%) whereas the remaining percentage was constituted by those with posterior epistaxis.Posterior epistaxis was more common among patients aged 21-40 years (40.7%) compared to patients aged 0-20 years (20%). 75% of the patients had epistaxis due to local etiologies while 25% was due systemic causes. Majority of patients with epistaxis had history of trauma (25%). Other reported aetiologies were malignancy of nasal and post-nasal space (22%) and hypertension (15%). Anterior nasal packing was the most commonly used method in management of patients with epistaxis compared to conventional posterior nasal packs. Fewer number of patients required surgery as the treatment modality where 3% of the patients undergone electro cauterization and only 1% required external carotid artery ligation.Key words: Epistaxis, Otorhinolaryngology, MOI, MNH, Tanzani