title: Waiting time for emergency abdominal surgery in Zaria, Nigeria.
abstract: 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.
authors.affiliation: Ahmadu Bello University Teaching Hospital, Ahmadu Bello University, Nigeria. mrahmed1010@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Adamu
authors.forename: M
authors.initials: M
authors.lastname: Maigatari
authors.forename: K
authors.initials: K
authors.lastname: Lawal
authors.forename: M
authors.initials: M
authors.lastname: Iliyasu
mesh_terms: 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
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