General Surgery

Magnitude of Appropriate Use of Surgical Antibiotic Prophylaxis and Associated Factors Among Surgical Operated Patients in Tibebe Ghion Specialized Hospital, Bahirdar, Northwest Ethiopia

Fri, 10 Nov 2023 00:00:00 GMT

Magnitude of Appropriate Use of Surgical Antibiotic Prophylaxis and Associated Factors Among Surgical Operated Patients in Tibebe Ghion Specialized Hospital, Bahirdar, Northwest Ethiopia Mulat, Agalu Excessive and inappropriate use broad spectrum antibiotics for surgical prophylaxis has led to development antimicrobial resistance, reduced treatment efficacy, a rise in morbidity and mortality and increased costs. The aim of this study is to assess magnitude of appropriate use and adherence of antimicrobial usage in surgical prophylaxis to the clinical antibiotics prophylaxis guidelines Objective:To assess magnitude of appropriate use of surgical antibiotic prophylaxis and associated factors among surgical operated patients in Tibebe Ghion Specialized Hospital, Bahirdar city, Ethiopia, 2023 Methods: Hospital based cross-sectional study of all patients operated in general surgery wards in TGSH BahirDar city from January to August 2023 was conducted.Systematic sampling technique by was used and the final sample size for the study was 422.The data was collected using standard check list and using patient’s medical record, inpatient and outpatient registry book, and OR logbook as a source of data. The collected data was entered into SPSS 27 for analysis. Bivariate and multivariate logistic regression was done at p-value 0.05 and model fitness was cheeked using hosmer and lemeshow. Binary regression model was used. The result is presented in tables, charts and graphs. Results: A total of 412 patients medical records were evaluated and out of them 355(86.2%) of cases received prophylactic antibiotics. Among the patients for whom prophylaxis administered, 79(22.3%) of prescriptions were appropriate. Ceftriaxone and metronidazole were most commonly prescribed prophylactic agents in 209(58.9%)The mostcommon reasons for appropriate prophylaxis were dosage, 355(100%), indication, 328(92.4%), duration of administration, 238(67%), choice of antibiotics, 110(31%) and timing of administration, 91(25.6%). Availability of first line prophylactic antibiotics is 16.8 times increased appropriateness of surgical antibiotic prophylaxis use than non-availability at the time of prescription (AOR95%CI=16.834(7.687-36.865, p=0.01). Patients after prostatectomy received prophylactic antibiotics 4.115 times appropriately than patients after cholecystectomy (AOR=4.115(95%CI, 1.404-12.048, p-value=0.010)). Patients for whom thyroidectomy done received SAP 23.255 times appropriately than patients after cholecystectomy (AOR=23.255(95%CI, 2.967-71.428, p value=0.001)) and patients after hernia repair received 48.64times more appropriately than patients after cholecystectomy (AOR=48.64(95%CI, 10.622-222.144, p value=0.000)) Conclusions: Appropriate use of surgical antibiotic prophylaxis is low in surgical wards of TGSH and ceftriaxone and metronidazole were most common prescriptions as surgical prophylaxis. To improve appropriate use, ensure availability of first line antibiotics, provision of continuouseducation and escalation of short-term training of prescribers for appropriate use ofantibiotics and preparation of local surgical antibiotics prophylaxis guidelines and protocols should be considered. Key words: Surgical antibiotic prophylaxis, surgical ward, BahirDar University

Perioperative Surgical Management Outcome And Associated Factors Among Patients With Perforated Peptic Ulcer Disease Intertiary Centers, Bahirdar, Ethiopia

Fri, 10 Nov 2023 00:00:00 GMT

Perioperative Surgical Management Outcome And Associated Factors Among Patients With Perforated Peptic Ulcer Disease Intertiary Centers, Bahirdar, Ethiopia Bametaw, chalie Background: Perforated peptic ulcer is a life-threatening complication with a high morbidity and mortality. It is the most common indication for emergency operation and remains a significant healthcare problem, which can consume considerable financial resources.Aim of this study is to assessperioperativesurgical management outcome and associated factors among patients with perforated peptic ulcer disease at tertiary hospitals in BahirDar,Ethiopia, in 2023 Methods:Institution based retrospective study designwas conducted to assess perioperative surgical management outcomes of perforated peptic ulcer disease atTibebeGion Specialized Hospital and FelegeHiwot Specialized Hospitalby reviewing a 4 years datafromSeptember 12, 2019 to September 11, 2023. Results:A total of 118 patients with perforated peptic ulcer disease were operated in a 4 yearperiod. Hundred five (105) (89 %) patients were males and 13(11%) were females with 6.8:1 male to female ratio. The mean and median age of patients was 43.09± 15.34 and 42 years respectively. The peak incidence was between 31 and 45 years (33.1%). Most (81.4%) were from rural area.The mean and median duration of presentation onset of symptom were 42.63 ± 27.394 and 30.50 hours respectively. Most(56.8%) present after 24 hours.Themean and median level of GI contamination was found to be1193.64±1058.72 and 800.00 ml respectively. Duodenalperforation was found in 108 (91.5%) patients. The mean size of perforation was 7.32 ±3.44 mm. Graham's patch was the choice of procedure in all cases. Drain was used in 94.9 % of cases.Postoperative complications occurred in 21 (17.8%) patients and 6(5.1%) patients died before discharge while others discharged improved. The most common complications were SSI (6.8%), pneumonia (3.4%) and re-laparotomy (3.4%).Sizeof perforation is associated with overall adverse outcome, (p=0.022) respectively. Conclusion:Perforated PUD is common among young males. Seventy eight percent of our patients have overall favorable outcome and mortality and morbidity is quite acceptable. Size of perforation significantly associated with overall adverse outcome. Keywords:peptic ulcer disease, perforated peptic ulcer disease, outcome, associated factors, prognostic factors

Magnitude Of Re-Laparatomy and Associated Factors Among Adult Patients Undergoing Laparotomy in Tibebe Gion Specialized Hospital, Northwestethiopia

Sun, 10 Sep 2023 00:00:00 GMT

Magnitude Of Re-Laparatomy and Associated Factors Among Adult Patients Undergoing Laparotomy in Tibebe Gion Specialized Hospital, Northwestethiopia Bekele, Tewlegn Background. Re-laparotomy refers to operations performed within 60 days of an initial laparotomy. Magnitude of re-laparotomy is highly variable worldwide in various reported studies and highest was seen in gastrointestinal surgeries, while lowest in vascular surgeries. Re laparotomy is one of the causes of morbidity and mortality among patients with abdominal surgery. The costs, length of hospital stay and the psychological impact on patients and their families are high. Either globally or nationally the studies conducted about this problem are minimal. Evidences in Ethiopia shows that magnitude of re-laparotomy and its morbidity and mortality is increasing. In TibebeGion Specialized hospital, study was not conducted on this problem even if increasing number of re-laparotomy cases. Unless efforts are made to prevent it in advance by identifying its potential risk factors, it will continue as major public health problem of the country. Objectives: The aim of the study was to assess the magnitude and factors associated with re- laparotomy among adult laparotomy patients in TibebeGion specialized hospital. Methods: The study was conducted using a cross-sectional and monocentric study over a one-year period and included 389 adult patients who undergo laparotomy in TibebeGhion Specialized Hospital, Department of Surgery from September 2022 to August 2023 G.C. Patients with laparotomy cases were reviewed and analysed. Binary and multi variable logistic regression analysis was used to analyse the association between variables. The data wasentered and analysed using SPSS software version 25 and the results were described by using descriptive statics like summary value, tables of frequency, graphs and the associated factors for re-laparotomy were identified by using multiple binary logistic regression analysis with P value < 0.05 were considered statistically significant. Result: The magnitude of re laparotomy was 9 %, with 95 %( CI= 6.2-11.8) .In this study ,patients age above 60 years, (AOR = 16.36, 95% CI = [3.5-35]), P value = 0.002), duration of illness more than 120 hours , (AOR = 5.13, 95% CI= [1.35-22]) , pre-operative pulse rate more than 120 beats per minute, (AOR = 9.35, 95% CI= [3.06-19.43], dirty wound at index laparotomy, (AOR = 4.81, 95% CI = [1.23-10.05])were associated with re-laparotomy. Conclusion and recommendation; In TGSH, the magnitude of relaparotomy was high. Creating awareness on the community about the importance of early visit of health facilities when they feel illness will decrease the risk of relaparotomy. Key words: Re-laparotomy, site of pathology, peritonitis, wound dehiscence, Bahir Dar

Postoperative Ileus Magnitude and Associated Factor Among Patients Underwent Abdominal Surgery at Specializedhospitals In Bahirdar, Ethiopia: A Cross-Sectional Study 2023

Sun, 10 Dec 2023 00:00:00 GMT

Postoperative Ileus Magnitude and Associated Factor Among Patients Underwent Abdominal Surgery at Specializedhospitals In Bahirdar, Ethiopia: A Cross-Sectional Study 2023 Fasika, Chanie Background: Postoperative ileus is a well-known consequence and complication of gastrointestinal, pelvic, and some non-abdominal surgeries, resulting in significant morbidity and patient discomfort and dissatisfaction. It is a virtually universal complication after abdominal surgery that prolongs duration of hospitalization. Postoperative ileus has a great economic burden and, interestingly, it was as expensive as managing severe postoperative complications (such as deep venous thrombosis, pulmonary embolism, and surgical site infection) that might not lead to ileus. Objective: The main objective of this study is to assess the magnitude and associated risk factors of postoperative ileus among adult patients underwent abdominal surgery at Tibebe Gihon specialize hospital & Felegehiwot Comprehensive Specialize Hospital, Bahirdar, Ethiopia Method: Institution based multicenter cross-sectional study was conducted on patients who underwent abdominal surgeries at governmental specialized hospital in Bahirdar from September 20 to November 20 2023. A total of 252 selected from the two hospitals by consecutive sampling techniques and included in the final analysis. Before being imported into STATA/MP version 17, the data were originally input into Epidata version 4.6. The analysis fitted in bivariable and multivariable binary logistic models to find the explanatory variables. The 95% confidence interval of the odds ratio was calculated, and factors with a p-value less than 0.05 in the multivariable model were declared significantly associated with the dependent variable. Results: Themagnitude of Postoperative ileus at selected hospitals in Bahir Dar was16.27% (95% CI: 12.19%, 21.38%).Age (AOR= 3.81, 95%CI: 1.41, 10.33), BMI(AOR= 11.54, 95%CI: 1.97, 67.55),intestine surgery (AOR= 3.27, 95% CI: 1.01, 11.77)were significantly associated with Postoperative ileus. On the other hand being female decrease the risk of Postoperative ileus by 61 %(AOR= 0.39, 95%CI: 0.15, 0.97). Conclusion: Magnitude of Postoperative ileus among patients underwent abdominal surgery in Bahir Dar was an average when compare it with results reported from different studies. Old age, male sex, low BMI and intestinal surgeries were significant determinant factors associated with Postoperative ileus.