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

Cost effective oesophageal intubation

Carcinoma of the oesophagus presents a multitude of challenges of patient care in  Africa The majority of patients present with very advanced manifestations of the disease. The treatment options are usually few and limited to palliation. Placement of an endoprosthetic tube is one method which is commonly undertaken and very often provides satisfactory palliation, with restoration of swallowing

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

Disability associated with low back pain in Mulago Hospital, Kampala Uganda

Background: Low back pain is sufficiently disabling and a common cause of disability particularly during the productive middle years of adult life. Disability implies interference with daily activities. Objective: To assess and document the disability associated with low back pain in terms of sick leave days, interference with daily activities and some pain characteristics. Methods: This study was carried out in the Orthopaedic out patient clinic of Mulago Hospital, a tertiary national referral hospital in Kampala, Uganda. It was a descriptive cross sectional study over a period of seven months. 204 patients with mechanical back pain were enrolled in the study, after screening all consecutive new adult patients referred with low back pain as the major complaint. A validated modified Oswestry instrument was used to collect data. Nine daily activities: sleep, sex, lifting, traveling, social and recreational activities, dressing, sitting, walking and running activities were investigated. Data was analyzed using SPSS for windows version 10. Mean and Standard deviations were used to summarize continuous variables. P value was considered statistically significant if it was equal or less than 0.05. Results: 87% of the respondents reported a mean of 14 days off work during the 4 weeks prior to the interview because of back problems. The mean duration of a current low back pain episode was 5 months. All activities were interfered with; with lifting as the most affected with a mean score of 4.5, walking and running was 3.6, standing was 3.3, sex life was 2.9, traveling was 2.9, sitting was 2.7, social and recreational activities was 2.7, getting dressed was 2.1 and sleeping was 1.8. Conclusion: Our results confirm that low back pain is a significant cause of disability affecting the productive middle years of adult life and causes significant disruption of daily activities including sleep and sex. The cost of lost work time, compensation and treatment for our setting is a knowledge gap that should be filled by further study. There is need for a community-based study to ascertain extent of the problem in at a wider population level. African Health Sciences Vol. 6(3) 2006: 173-17