Early Postoperative Complications of Gastrointestinal Surgery and Its Associated Factors in Yemeni Patients Treated in a Teaching Hospital: A Retrospective Monocentric Study

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Abstract

Background Postoperative complications (POCs) are significant concerns to surgeons because of their possible fatality or long-term disabilities. This study aimed to investigate the early POCs of gastrointestinal surgery and its associated factors in Yemeni patients treated in a teaching hospital in Sana'a University referral hospital. Method A retrospective cross-sectional study from June 2016 to June 2020 was conducted at Al-Kuwait Teaching Hospital, Sana'a University, Yemen. The patients' characteristics, causative factors, primary treatment, and POCs were recorded from their medical profiles. Univariate analysis was utilized to identify the risk factors associated with gastrointestinal POCs within 30 postoperative days. Results The 30-postoperative day mortality was 3.6%, and major POCs occurred in 22 (20%) patients. There is no statistically significant relationship between POCs and age, sex, smoking, khat chewing, comorbidities (diabetes mellitus, anemia, jaundice, heart disease), emergency cases, drain insertion, and operative time (p ˃ 0.05). There was a significant relationship between POCs and preoperative poor nutritional status, high American Society of Anesthesiologists (ASA) grade, need for blood transfusion, major abdominal surgeries, iatrogenic injury, small bowel resection, reoperation, and history of the previous laparotomy (p ≤ 0.05). Conclusion There is a significant relationship between preoperative poor nutritional status, high ASA, need for blood transfusion, major abdominal surgeries, reoperation, small bowel resection, iatrogenic injury, previous laparotomy, and POCs across different gastrointestinal procedures. These factors should be assessed when auditing surgical outcomes.

Keywords: abdominal surgery; complications; early postoperative; risk factors; small bowel resection.

Conflict of interest statement

The authors have declared that no competing interests exist.


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References

  1.  
    1. Size and distribution of the global volume of surgery in 2012. Weiser TG, Haynes AB, Molina G, et al. Bull World Health Organ. 2016;94:201–209. - PMC - PubMed
  2.  
    1. Rates and patterns of death after surgery in the United States, 1996 and 2006. Semel ME, Lipsitz SR, Funk LM, Bader AM, Weiser TG, Gawande AA. Surgery. 2012;151:171–182. - PubMed
  3.  
    1. Postoperative complications and implications on patient-centered outcomes. Tevis SE, Kennedy GD. J Surg Res. 2013;181:106–113. - PMC - PubMed
  4.  
    1. Implications of multiple complications on the postoperative recovery of general surgery patients. Tevis SE, Cobian AG, Truong HP, Craven MW, Kennedy GD. Ann Surg. 2016;263:1213–1218. - PMC - PubMed
  5.  
    1. Hospital cost-analysis of complications after major abdominal surgery. Straatman J, Cuesta MA, de Lange-de Klerk ES, van der Peet DL. Dig Surg. 2015;32:150–156. - PubMed
  6.  
    1. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Clavien PA, Sanabria JR, Strasberg SM. http://ci.nii.ac.jp/naid/10017317283/en. Surgery. 1992;111:518–526. - PubMed
  7.  
    1. Hospital and payer costs associated with surgical complications. Healy MA, Mullard AJ, Campbell DA Jr, Dimick JB. JAMA Surg. 2016;151:823–830. - PubMed
  8.  
    1. Postoperative complications: an observational study of trends in the United States from 2012 to 2018. Dencker EE, Bonde A, Troelsen A, Varadarajan KM, Sillesen M. BMC Surg. 2021;21:393. - PMC - PubMed
  9.  
    1. Key factors associated with postoperative complications in patients undergoing colorectal surgery. Manilich E, Vogel JD, Kiran RP, Church JM, Seyidova-Khoshknabi D, Remzi FH. Dis Colon Rectum. 2013;56:64–71. - PubMed
  10.  
    1. The association between modifiable lifestyle factors and postoperative complications of elective surgery in patients with colorectal cancer. Loogman L, de Nes LC, Heil TC, et al. Dis Colon Rectum. 2021;64:1342–1353. - PMC - PubMed
  11.  
    1. Risk factors for mortality and postoperative complications after gastrointestinal surgery. Sørensen LT, Malaki A, Wille-Jørgensen P, et al. J Gastrointest Surg. 2007;11:903–910. - PubMed
  12.  
    1. Risk factors for 30-day hospital readmission among general surgery patients. Kassin MT, Owen RM, Perez SD, et al. J Am Coll Surg. 2012;215:322–330. - PMC - PubMed
  13.  
    1. Factors associated with postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians. Kim YW, Kim IY. Clin Interv Aging. 2016;11:689–697. - PMC - PubMed
  14.  
    1. Predictive factors for surgical site infection in general surgery. Haridas M, Malangoni MA. Surgery. 2008;144:496–501. - PubMed
  15.  
    1. A pilot study evaluating predictors of postoperative outcomes after major abdominal surgery: physiological capacity compared with the ASA physical status classification system. Hightower CE, Riedel BJ, Feig BW, et al. Br J Anaesth. 2010;104:465–471. - PMC - PubMed
  16.  
    1. Risk factors for tissue and wound complications in gastrointestinal surgery. Sørensen LT, Hemmingsen U, Kallehave F, Wille-Jørgensen P, Kjaergaard J, Møller LN, Jørgensen T. Ann Surg. 2005;241:654–658. - PMC - PubMed
  17.  
    1. Wound disruption following colorectal operations. Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Mills S, Pigazzi A, Nguyen NT, Stamos MJ. World J Surg. 2015;39:2999–3007. - PubMed
  18.  
    1. Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. Sciuto A, Merola G, De Palma GD, Sodo M, Pirozzi F, Bracale UM, Bracale U. World J Gastroenterol. 2018;24:2247–2260. - PMC - PubMed
  19.  
    1. A multivariate analysis of potential risk factors for intra- and postoperative complications in 1316 elective laparoscopic colorectal procedures. Kirchhoff P, Dincler S, Buchmann P. Ann Surg. 2008;248:259–265. - PubMed
  20.  
    1. Indications and outcome of patients who had re-laparotomy: two years' experience from a teaching hospital in a developing nation. Abebe K, Geremew B, Lemmu B, Abebe E. Ethiop J Health Sci. 2020;30:739–744. - PMC - PubMed
  21.  
    1. Khat (Catha edulis): health aspects of khat chewing. Hassan NA, Gunaid AA, Murray-Lyon IM. http://apps.who.int/iris/handle/10665/117302. East Mediterr Health J. 2007;13:706–718. - PubMed
  22.  
    1. The assessment of complications after major abdominal surgery: a comparison of two scales. Veličković J, Feng C, Palibrk I, Veličković D, Jovanović B, Bumbaširević V. J Surg Res. 2020;247:397–405. - PubMed
  23.  
    1. Postoperative complications and mortality after major gastrointestinal surgery. Jakobson T, Karjagin J, Vipp L, et al. Medicina (Kaunas) 2014;50:111–117. - PubMed
  24.  
    1. Assessment of wound healing in relation to nutritional status of the patients in common surgical condition in tertiary care centre. Singh R, Tripathi SS, Tripathi A, Pandey H. Int Surg J. 2019;6:7.
  25.  
    1. Malnutrition in the outcome of wound healing at public hospitals in Bahir Dar City, Northwest Ethiopia: a prospective cohort study. Fentahun N, Anteneh Y, Menber Y. J Nutr Metab. 2021;2021:8824951. - PMC - PubMed
  26.  
    1. Postoperative complications and associated factors among surgical patients treated at a tertiary hospital, Eastern Ethiopia: a prospective cohort study. Bayissa BB, Mummud M, Miressa F, Fekadu G. Open Access Surg. 2021;14:37.
  27.  
    1. Complications in colorectal surgery: risk factors and preventive strategies. Kirchhoff P, Clavien PA, Hahnloser D. Patient Saf Surg. 2010;4:5. - PMC - PubMed
  28.  
    1. A meta-analysis of randomized controlled trials on the use of suction drains following rectal surgery. Guerra F, Giuliani G, Coletta D, Boni M, Rondelli F, Bianchi PP, Coratti A. Dig Surg. 2018;35:482–490. - PubMed
  29.  
    1. Reoperation as a quality indicator in colorectal surgery: a population-based analysis. Morris AM, Baldwin LM, Matthews B, Dominitz JA, Barlow WE, Dobie SA, Billingsley KG. Ann Surg. 2007;245:73–79. - PMC - PubMed