Oesophageal cancer management guidelines for Uganda

No Abstrac

Early Outcome of Postoperative Pyrexia Following Major Surgery in Mulago Hospital

Background: This study was undertaken with the main objectives of determining the incidence, the associated factors and the early outcome of postoperative pyrexia and documenting the use of perioperative antibiotic therapy in the elective major surgical patient. Methods: This was a 5months prospective study carried out in the surgical wards of Mulago Hospital in Uganda. The study variables including socio-demographic characteristics, type of surgery, surgical approach and procedure, operative diagnosis, use of antibiotics, operative wound, and usage of drains, blood transfusion and preoperative stay were recorded in 168 patients undergoing elective major surgery. Six hourly body temperatures were recorded and all patients were daily reviewed for infections and malaria. Laboratory investigations were clinically oriented. Results: Postoperative pyrexia occurred in 13.7% of patients undergoing elective major surgery. Malignancy, intestinal resection and anastomosis, urinary catheterization, nasogastric tube, intraoperative blood transfusion and prophylactic antibiotics were significantly associated with postoperative pyrexia (p<0.05). Surgical site infection, chest infection, urinary tract infection and malaria were the major causes of postoperative pyrexia. Prophylactic antibiotics were used in 16.7% of the patients whereas liberal postoperative antibiotic prescription was done in 93.5% for an average duration of 5 days. Postoperative pyrexia significantly increased the length of hospital stay (p=0.016). Conclusion: Infections and malaria are important causes of postoperative pyrexia. All pyrexial patients should be investigated for malaria. There is a need for a policy regarding the use of perioperative antibiotics in Mulago hospital

POSSUM Scoring System In Patients Undergoing Laparotomy In Mulago Hospital.

Background: Prediction of complications is an essential part of risk management in surgery. Knowing which patient to operate and those at high risk of developing complications contributes significantly to the quality of surgical care and cost reduction in surgery. The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) was used to score and predict the outcomes of Laparotomy in Mulago Hospital. The main objective of this study was to determine the morbidity and mortality POSSUM scores for patients who underwent Laparotomy in Mulago Hospital, between September 2003 and February 2004. Methodology: Consecutive patients, who underwent a Laparotomy in the three surgical wards in Mulago Hospital, were scored using POSSUM system. For each patient the predicted risk of mortality and morbidity was calculated from POSSUM equation. Multivariate logistic regression analysis was used to determine the relationships between the predicted and observed morbidity and mortality rates. Postoperative complications and mortality within 30days were described. Results: Seventy-six patients were studied. The observed and expected mortality and morbidity rates were 14.5%, 2.6% and 35.4%, 0% respectively. Physiological scores, operative scores, co morbid condition such as Diabetes Mellitus significantly determined the outcomes. Conclusion: POSSUM scoring system can be used to predict the risk of mortality but not morbidity for patients admitted to a surgical ward in Mulago Hospital. Recommendations: The POSSUM scoring system can be used in decision-making process before a Laparotomy is carried out

The Postoperative Complications Prediction in Mulago Hospital using POSSUM Scoring System

Introduction: Prediction of complications is an essential part of risk management in surgery. Knowing which patient to operate and those at high risk of developing complications contributes significantly to the quality of surgical care and cost reduction. The postoperative complications of patients who underwent Laparotomy in Mulago Hospital were studied using POSSUM scoring system. The main objective of this study was to determine the postoperative complications of Laparotomy in Mulago Hospital, between September 2003 and February 2004. Methods: Consecutive patients, who underwent Laparotomy in Mulago, were studied using POSSUM system for development of complications. For each patient operated, they were followed up in wards until discharge. When the postoperative complications were reported, they were reexamined by the surgeons, treated and followed up for 30 days postoperatively. Phone contacts were used for the follow up. Surgical reviews were conducted once a week in Mulago Hospital and the data obtained recorded in the data sheet for the patients. Results: Seventy-six patients were studied. The observed post operative complications were as follows: Respiratory tract infection (28.2%), wound haemmorrhage (18.2%), anaemia (15.5%), hypotension (14.1%), UTI (2.2%), Anastomotic leak (1.4%), Wound sepsis (9.9%), wound dehiscence (4.2%), Thromboembolism (1.4%). The postoperative nursing care significantly determined the outcomes. Conclusion: Postoperative complications can be predicted in the modern management of surgery especially while using a scoring system