Waiting time for emergency abdominal surgery in Zaria, Nigeria.
BACKGROUND
Management of surgical emergencies in Nigeria is characterised by mismatch between supply of facilities and demand for care. This study aimed to evaluate the waiting time between presentation at hospital with acute abdominal disease and operative intervention.


METHODS
We prospectively studied adult patients with abdominal diseases requiring emergency operation. The interval between presentation and first contact with emergency room doctors was defined as T1; time from contact to decision to operate as T2; time taken to resuscitate patient T3 and to commencement of operation T4. Causes of delay and its impact on outcome of treatment were noted.


RESULTS
There were 488 patients, mean age 32 +/-1.7 SD years. TT ranged between 0.8 and 79.0 hours, mean 22.3 +/- 10.0 hours. In 81.6% operative intervention was delayed beyond 6 hours of which financial constraints accounted for 53.8%. T3 accounted for the longest delay (0.5 -53.0 hours). Patients of lower socio-economic class had longer T3 (p<0.005). Waiting for complementary investigations caused delay in 22.1%. Post-operative complications (p=0.0001) and their severity were higher in patients with longer TT. Prolonged TT (p<0.001), ASA grade (0.005) and time from onset of symptoms to admission (p=0.009) were associated with mortality. Patients whose operations were delayed beyond 24 hours had a longer hospital stay.


CONCLUSIONS
Emergency abdominal operations were delayed in our patients mainly because of scarce financial resources. Delayed interventions were associated with higher morbidity and mortality.
Adamu
A
A
Ahmadu Bello University Teaching Hospital, Ahmadu Bello University, Nigeria. mrahmed1010@yahoo.com
Maigatari
M
M
Lawal
K
K
Iliyasu
M
M
D000006:Abdomen, Acute / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000191:economics / Q000401:mortality*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009549:Nigeria / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality*; D011247:Pregnancy; D011446:Prospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
Ann Trop Paediatr. 1999 Sep;19(3):267-72
10715713
Curr Opin Crit Care. 2008 Aug;14(4):423-7
18614906
Ann Fr Anesth Reanim. 2003 Mar;22(3):189-95
12747986
Anaesthesia. 2001 Jul;56(7):684-9
11437772
Am J Med. 2004 Aug 1;117(3):175-81
15276596
Int J Clin Pract. 2005 Jun;59(6):716-20
15924601
Afr J Med Med Sci. 2004 Jun;33(2):135-8
15565931
Arch Surg. 2009 Feb;144(2):122-7; discussion 128
19221322
Ann R Coll Surg Engl. 1995 May;77(3 Suppl):121-4
7574304
Br J Surg. 2007 Feb;94(2):214-21
17205491
Hong Kong Med J. 2000 Sep;6(3):254-9
11025842
Br J Surg. 1999 Dec;86(12):1567-72
10594507
J Public Health Med. 2000 Jun;22(2):182-90
10912557
Ann R Coll Surg Engl. 1990 Jul;72(4):236-8
2382945
Niger Postgrad Med J. 2006 Sep;13(3):172-5
17066100
Afr J Med Med Sci. 2002 Mar;31(1):59-62
12518932
J Am Coll Surg. 2007 Nov;205(5):704-11
17964447
Ann Surg. 2006 Nov;244(5):656-60
17060754
J Natl Med Assoc. 2004 Jun;96(6):850-2
15233497
Trop Doct. 2005 Oct;35(4):193-4
16354463
World J Emerg Surg. 2006 Mar 24;1:7
16759405
Med Trop (Mars). 2002;62(3):237-41
12244918
J R Soc Med. 2001 Apr;94(4):180-2
11317620
Niger Postgrad Med J. 2003 Sep;10(3):140-3
14692054
World J Surg. 2005 Jun;29(6):804-7; discussion 808
15880283