Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria

Background and Objectives: Post-operative pulmonary complications (PPCs) are recurring causes of rising morbidity and mortality in surgeries. This study sought to evaluate pre-operative risk factors for PPCs in abdominal surgerypatients in Nigeria.Methodology: This was a prospective study in patients booked for surgery in 2014. Biodata, medical his tory, pre-operative respiratory and cardiovascular examination findings, body mass index, serum albumin, serum urea, ventilatory function, chest x-rays and oxygen saturation were obtained. The association between pre-operative variables and PPCs was determined.Results: The pre-operative spirometry was predominantly restrictive (62%). Overall, the prevalence of PPCs was 52%. This included non-productive cough (14%), isolated productive cough (10%), productive cough with abnormal chest finding (16%), pneumonia (8%), pleural effusion (5%), ARDS (2%). Percentage predicted FEV1 and FVC were lower in participants with PPCs. (p= 0.03 and p=0.01respectively). Pre-operative cough, shortness of breath and consolidation were associated with PPCs (p< 0.05). Post-operative respiratory rate and pulse rate in participants with PPCs were higher than the values in those without PPCs (p=0.03 and p=0.05).Conclusion: The prevalence of PPCs was high in this study. Pre-operative cough, shortness of breath, consolidation, abnor- mally low percentage predicted FEV1 and FVC were associated with PPCs.Keywords: Post-operative pulmonary complications, pre-operative assessment, risk factors, cough, shortness of breath, consol- idation, pneumonia, elective abdominal surgeries, Nnewi, Nigeria

Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria

Background and Objectives: Post-operative pulmonary complications (PPCs) are recurring causes of rising morbidity and mortality in surgeries. This study sought to evaluate pre-operative risk factors for PPCs in abdominal surgerypatients in Nigeria. Methodology: This was a prospective study in patients booked for surgery in 2014. Biodata, medical his tory, pre-operative respiratory and cardiovascular examination findings, body mass index, serum albumin, serum urea, ventilatory function, chest x-rays and oxygen saturation were obtained. The association between pre-operative variables and PPCs was determined. Results: The pre-operative spirometry was predominantly restrictive (62%). Overall, the prevalence of PPCs was 52%. This included non-productive cough (14%), isolated productive cough (10%), productive cough with abnormal chest finding (16%), pneumonia (8%), pleural effusion (5%), ARDS (2%). Percentage predicted FEV1 and FVC were lower in participants with PPCs. (p= 0.03 and p=0.01respectively). Pre-operative cough, shortness of breath and consolidation were associated with PPCs (p<0.05). Post-operative respiratory rate and pulse rate in participants with PPCs were higher than the values in those without PPCs (p=0.03 and p=0.05). Conclusion: The prevalence of PPCs was high in this study. Pre-operative cough, shortness of breath, consolidation, abnormally low percentage predicted FEV1 and FVC were associated with PPCs. DOI: https://dx.doi.org/10.4314/ahs.v19i1.51 Cite as: Ufoaroh CU, Ele PU, Anyabolu AE, Enemuo EH, Emegoakor CD, Okoli CC, et al. Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria. Afri Health Sci. 2019;19(1). 1745-1756. https:// dx.doi. org/10.4314/ ahs. v19i1.5

Malignant melanoma in a Nigerian tertiary hospital

Background: Malignant melanoma is a neoplasm of melanocytes which usually arises from the skin and other parts of the body where melanocytes exist. The incidence is low in black Africa and occurs mostly in the extremities. Surgery is the main stay of treatment for localised disease.Methodology: A 5-year retrospective study of patients with histological diagnosis of malignant melanoma at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.Results: A total of 14 patients with 15 lesions of cutaneous malignant melanoma were managed during the study period. Their age range was 42-85years, and the female:male ratio was 2:1. Plantar melanoma was the most common occurrence, and only 3 patients had previous history of trauma. Surgery was the mainstay of treatment.Conclusion: Malignant melanoma remains a rare condition. Sole of the foot is the most common site.Keywords: Dacarbazine, plantar melanoma, wide local excisio

Early feeding following elective laparotomy with gut anastomosis in surgical patients

Background: Early oral feeding has been listed as one of many factors that contribute to enhancing recovery after laparotomy due to its effect on postoperative ileus. Objectives: The aim of the study was to compare early feeding against controls on the reduction of postoperative ileus among patients undergoing elective laparotomy. Methodology: Consenting patients who had elective laparotomy with gut anastomosis in the Surgical wards of NAUTH Nnewi were randomised into Early feeding group and Control/ traditional delayed feeding group. In the Early feeding group, patients’ NGTs were removed within first 24 hours and graded oral intake was commenced. In the Delayed feeding group, patients were used as controls and were managed in the traditional way-nil by mouth until passage of flatus or faeces. Assessed outcome measure was time from completion of surgery to passage of flatus and faeces. Results: During the study period, December 2014 to November 2016 (2 years), 72 consenting patients who had elective laparotomy in the Surgical wards were randomised into the two groups- Group1 (n=36); Group 2 (n=36). The groups were similar in terms of gender, age, surgical procedures, and co morbidity. The age range was 20-81 years. The time from completion of surgery to first passage of flatus was 3.85days for Group1 and 3.92days for Group 2. Time from completion of surgery to first passage of stool was 4.57days for Group 1 and 4.76days for Group2. The time to flatus and faeces was shorter in early feeding compared to Controls but did not reach statistical significance (p0.115, p0.116 respectively). There were no significant differences noted in the complication rates among the groups. Conclusion: There was no statistically significant difference in the time to passage of flatus and faeces between the Early oral feeding group and controls.</jats:p

Retained surgical sponge presenting as a case of intestinal obstruction

Retained surgical sponge or gossypiboma is a term used to describe a retained swab in the body after operation. There are different surgical materials that can be left in the abdomen during operation such as sponge, artery forceps, scissors, and pieces of broken instrument. Mop is the most commonly retained foreign body. Inadvertent retention of foreign body in the abdomen often requires another operation, increasing the morbidity and mortality in these patients. Despite the complications associated with this condition, they are rarely published because of medicolegal implications. We report a case of 28-year-old woman who presented on account of 9 months history of colicky abdominal pain, abdominal distention and mass following open myomectomy in a private hospital.</jats:p