title: Determinants of decision-to-intervention time in the management and therapeutic outcome of emergency gynecological surgeries in south east Nigeria.
abstract: BACKGROUND
  Prompt and timely response in the management of gynecological surgical cases can significantly affect the therapeutic surgical outcome of patients in emergency situations. The aim of this study was to evaluate the decision-to-intervention time (DIT), its determinants, and the significance in the therapeutic outcome of emergency gynecological surgeries managed at a federal teaching hospital in south east Nigeria over an 18-month period.
  
  
  METHODS
  This was a prospective descriptive study of 105 emergency gynecological cases managed at a federal teaching hospital over an 18-month period. Patients were recruited at the point of admission and followed up until discharge for outcome. Data were abstracted with a data entry pro forma and then analyzed with the Epi Info™ statistical software version 7.0.
  
  
  RESULTS
  The incidence of gynecological surgical emergencies was 5.1% of the total gynecological cases managed during the study period. The mean DIT was 4.25 (range 1.45-5.50) hours with delay in intervention, mainly due to delays in securing blood/blood products and other materials for resuscitation (46.7%) and a lack of finance (15.2%). Six maternal deaths were recorded, giving a case fatality ratio of 5.7%, while the commonest maternal complications associated with the delays were hemorrhage (61.9%) and the need for blood transfusion (57.1%), respectively. The risk ratio of losing ≥1,000 mL of blood, anemia, hemorrhagic shock, and wound infection in those with DIT ≥120 minutes was statistically greater and significant at 95% confidence interval.
  
  
  CONCLUSIONS
  Inadequacies in health care services and policies due to poor infrastructure, organizational framework, and financing were the major determinants of the prolonged DIT and therapeutic outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria.
authors.forename: Azubuike Kanario
authors.initials: AK
authors.lastname: Onyebuchi
authors.affiliation: School of Postgraduate Studies, Department of Community Medicine, University of Nigeria, Enugu, Enugu State, Nigeria.
authors.forename: Lucky Osaheni
authors.initials: LO
authors.lastname: Lawani
authors.affiliation: Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria.
authors.forename: Peter O
authors.initials: PO
authors.lastname: Nkwo
authors.affiliation: Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria.
authors.forename: Chukwuemeka Anthony
authors.initials: CA
authors.lastname: Iyoke
authors.affiliation: Department of Obstetrics and Gynecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria.
authors.forename: Robinson Chukwudi
authors.initials: RC
authors.lastname: Onoh
authors.affiliation: Department of Obstetrics and Gynecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria.
authors.forename: Leonard O
authors.initials: LO
authors.lastname: Ajah
keywords: clinical risk; decision-to-intervention time; determinants; emergency; gynecological surgeries; therapeutic outcome
references.citation: BMJ. 2004 Mar 20;328(7441):665
references.pmid: 15023829
references.citation: Eur J Obstet Gynecol Reprod Biol. 2004 Sep 10;116(1):28-33
references.pmid: 15294363
references.citation: JNMA J Nepal Med Assoc. 2013 Jan-Mar;52(189):213-6
references.pmid: 23591298
references.citation: J Pregnancy. 2013;2013:393758
references.pmid: 23878737
references.citation: Obstet Gynecol. 2011 Apr;117(4):1032-1034
references.pmid: 21422884
references.citation: Trop Med Int Health. 2004 Mar;9(3):406-15
references.pmid: 14996371
references.citation: Am J Perinatol. 2004 Feb;21(2):63-8
references.pmid: 15017468
references.citation: BJOG. 2002 May;109(5):498-504
references.pmid: 12066937
references.citation: Int J Womens Health. 2013 Jul 12;5:407-12
references.pmid: 23874125
references.citation: J Obstet Gynaecol. 2005 May;25(4):342-6
references.pmid: 16091313
references.citation: BJOG. 2002 May;109(5):505-8
references.pmid: 12066938
references.citation: Ann Ib Postgrad Med. 2007 Jun;5(1):12-20
references.pmid: 25161432
references.citation: Geburtshilfe Frauenheilkd. 1996 Aug;56(8):423-30
references.pmid: 8974897
references.citation: Int J Womens Health. 2013 Aug 19;5:515-21
references.pmid: 23983494
references.citation: Qual Saf Health Care. 2007 Feb;16(1):60-6
references.pmid: 17301207
references.citation: J Minim Invasive Gynecol. 2014 Mar-Apr;21(2):196-202
references.pmid: 24126258
references.citation: BMJ. 2001 Jun 2;322(7298):1330-3
references.pmid: 11387177
references.citation: Obstet Gynecol. 2001 May;97(5 Pt 1):suppl 1-3
references.pmid: 11501566