East and Central African Journal of Surgery

Hospital-acquired infections in patients with surgical infections at a tertiary hospital in Kigali, Rwanda: A prospective observational study

2024-04-24T04:30:16+00:00

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Introduction: Hospital-acquired infections (HAIs) account for a substantial burden on healthcare systems, with surgical site infections being the most common. Limited data exist on HAIs in low-resource settings, particularly device-associated HAIs. This study aimed to characterize the incidence and different types of HAIs among patients with surgical infections in Kigali, Rwanda.

Methods: We conducted a prospective, observational study on all patients with surgical infections admitted to a tertiary referral hospital in Kigali. Patient demographics, clinical features, and outcomes, including HAIs, were analysed. Data on devices associated with HAIs, such as the use of Foley catheters, intubation outside of the operating theatre, and central lines, were also gathered. The incidence and types of HAIs were determined.

Results: Over 14 months, 124 patients were admitted and underwent surgery for surgical infections. Appendicitis (n=24, 19%), soft tissue infection (n=27, 22%), and abscesses (n=26, 21%) were the most common diagnoses. Seventy-three patients (59%) had comorbidities. Sixteen (13%) required postoperative admission to the intensive care unit. The perioperative mortality rate was 10% (n=13). Thirty-two patients (25%) developed HAIs. Urinary tract infections were seen in 2 patients (2%), and 1 patient developed pneumonia. In total, 30 patients (24%) had SSIs, with 15 (12%) experiencing superficial SSIs, 18 (15%) with deep SSIs, and 16 (13%) with organ-space SSIs. There were no instances of catheter-associated urinary tract infections, ventilator-associated pneumonia, or central line–associated bloodstream infections.

Conclusions: The incidence of HAIs among patients with surgical infections was high, with surgical site infections being the most prevalent. Minimizing device exposure is crucial for reducing the risk of other device-related HAIs.

A descriptive, cross-sectional analysis of occupational upper limb injuries at a tertiary trauma centre in Dar es Salaam, Tanzania

2024-04-24T04:46:00+00:00

[Accepted Research Article]

Background: The rise of occupational traumatic upper limb injuries, especially in the developing world, has largely been attributed to industrialisation. Inadequate occupational injury reporting systems and occupational health policies in the sub-Saharan region have resulted in limited research and publication on occupational traumatic upper limb injuries. The primary aim of this study was to assess the pattern and presentation of occupational traumatic upper limb injuries that were treated at Muhimbili Orthopaedic Institute, a tertiary hospital in Dar es Salaam, Tanzania.

Methods: This was a descriptive, cross-sectional, hospital-based study. All patients with occupational traumatic upper limb injuries were included. Data were collected using a structured questionnaire. Univariate analysis was used for categorical variables. Mean, range and standard deviation was used to analyse continuous variables. Statistical significance was determined in all relevant associations.

Results: A total of 74 patients were enrolled of whom 94.5% were males. The prevalence of occupational traumatic upper limb injuries in trauma patients was 2.9%. The mean age was 31.2 years. A large proportion (41.9%) of the patients were transport and distribution workers. Motor vehicle crashes were the most common cause of injury (40.5%) followed by heavy machinery injury (25.6%). The hand was the most common site of injury (47.3%). Fractures were the most observed injuries (85.1% of the patients). Heavy machine operators & assemblers were more likely to obtain high grade soft tissue injuries (p<0.0001) and suffer traumatic amputations (p<0.0001).

Conclusions: Males of productive age group were more affected by occupational injuries, many of whom were in the transportation industry. Heavy machine operators were more susceptible to severe soft tissue injuries with limb loss and thus calling for interventions from occupational safety and health authorities.

A retrospective, cross-sectional analysis of clinical and radiological outcomes following paediatric ureteric reimplantation at a tertiary hospital in Addis Ababa, Ethiopia

2024-04-24T05:17:53+00:00

[Accepted Research Article]

Background: Open ureteric reimplantation is considered to be the gold standard treatment for numerous anomalies involving vesico-ureteric junction. The study was conducted to determine the outcome of ureteric reimplantation surgeries in terms of clinical and radiologic improvement.

Methods: A retrospective cross-sectional study with a descriptive approach was implemented. All pediatric patients who underwent ureteric re-implantation surgery in Tikur Anbessa Hospital from September 1, 2015 to August 31, 2020 were included in the study. Data was collected using structured questionnaire from the patients' chart. Data was analysed using SPSS version 23. Patient characteristics, perioperative parameters, indications and outcomes of surgery studied.

Results: A total of 36 including 5 bilateral ureteric reimplantation were done for 31 patients during the study period. Among these 20(64.5%) were male while the rest were female; with male to female ratio of 1.8:1. Age ranged from 4 months to 12 years with the mean age of 41 months. Cohen trans-trigonal ureteric reimplantation techniques used in 22(61.1%), including all bilateral cases, while Politano-Leadbetter and Lich-Gregoire repair techniques used in 11(30.5%) and 3(8.3%) respectively. Complication occurred in 2(6.5%) patients. Around 94 % had their symptoms resolved and showed improvement on the degree of hydronephrosis as evidenced on ultrasound scan done within 6 months of surgical intervention which was confirmed with late ultrasound.

Conclusions: Pediatric open ureteric reimplantation is highly effective procedure in our setting. Ultrasound alone is found to be sufficient to follow the post-operative course of the disease in most patients without a need for other imaging studies.

Rotterdam computed tomography score as a predictor of early death among patients with traumatic brain injury at a tertiary hospital in Kampala, Uganda: A prospective study

2024-04-24T07:11:16+00:00

[Uncorrected Proof]

Background: Noncontrast computed tomography (CT) plays a crucial role in the assessment and triage of traumatic brain injured (TBI) patients. This study aimed to determine whether the Rotterdam CT score (RS) had good predictive value for short-term mortality among TBI patients in Uganda.

Methods: This was a hospital-based, prospective study of TBI treated in a tertiary, private hospital in Kampala, Uganda. A total of 108 TBI patients were consecutively enrolled from September 2017 through May 2018 and followed up from admission to either in-hospital death or discharge. Noncontrast CT brain imaging was conducted, and parameters of CT findings were used to calculate the RS. An area under the receiver operating characteristic (AUROC) plot of sensitivity vs specificity was generated to determine the discriminative power of the RS to predict in-hospital mortality.

Results: In total, 38% of TBI patients were aged 20 to 29 years, 25.9 % were aged 30 to 39 years, and 11% were over 50 years of age. Most patients were male (81.4%), while 19% were female. Six deaths occurred among study participants. Study mortality (5.6%) was lower than that predicted by the RS (11.1%). The AUROC for the RS was 68% (95% CI, 48% to 90%), indicating that it had poor to moderate power to predict short-term death in patients with TBI.

Conclusions: The Rotterdam CT score is a poor predictor for mortality of TBI in the short term.

A hospital-based retrospective study on the prevalence and pattern of cleft lip, cleft palate, and combined cleft lip and palate in Zimbabwe, January 1981 through December 1999

2024-04-24T08:26:07+00:00

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Background: Nonsyndromic cleft lip (CL), cleft lip and palate (CLP), and isolated cleft palate (CP) are the most common congenital anomalies of the orofacial region. The scarcity of data on the epidemiology of CL, CLP, and CP in Zimbabwe are limited to allow for development of policies on management and public education on these conditions. The aim of this study was to determine the prevalence, pattern, regional distribution, hospital stay after surgery, age at time of treatment and complications in Zimbabwe of patients with CL, CLP, CP and compare with similar results in the literature.

Methods: A retrospective study of 405 patients with CL, CLP and CP treated in two tertiary hospitals in Harare, Zimbabwe. Data was retrieved from hospital records of the patients and analysed using STATA 8.4.

Results: There were 49.8% males and 50.3% females. Most patients came from the Harare province (33.7%).CL was the most common anomaly (56%) with male preponderance (60.8%); CP was the second most common anomaly (40.8%), with female preponderance (45.8%); CLP was least common (3.3%) ,affecting 3.5% males and 3.3% females. Average age at the time of treatment for children was 9 months for CL, 12 months for CLP and 24 months for CP and in adults the average age was 21 years for CL, 33 years for CLP and 24 years for CP ; age range for patients who presented for surgery was 1 month to 60 years ; average hospital stay was 8.2 days ; complications recorded were infection (2.5%) and wound dehiscence (4%).

Conclusions: The study showed prevalence, gender distribution, pattern of clefts, and different pattern of distribution of the clefts within the country and complications rate similar to reports in the literature. However, there was a rather high CL prevalence, longer hospital stay and higher age at the time of treatment for both children and adults.

Complicated inguinal hernia in rural southeast Nigeria: A multicentre observational study on epidemiology and treatment outcomes

2024-04-24T08:54:10+00:00

[Accepted Research Article]

Background: There is enormous pool of unmet need for inguinal hernia (IH) repair in our environment due to numerous factors against elective repair. This has led to a large number of patients presenting emergently with complications. The aim of this study is to document the epidemiology and outcome of surgical management of complicated inguinal hernia (CIH) in a low income rural southeast Nigeria.

Methods: This was a multi-centre, retrospective cross-sectional analytical study of patients who received surgical treatment for CIH over eight years period (January 2013- December 2020) at three selected district hospitals in Southeast Nigeria. The trend over time and outcome of surgical treatment were evaluated. The main outcome measures analyzed were morbidity, mortality and length of hospital stay (LOHS). The various clinical, demographic and perioperative indices that impacted on morbidity and mortality were evaluated.

Results: Of the 540 patients evaluated, there were 89 (16.5%) bilateral and 451 (83.5%) unilateral IHs. Majority (78.5%) were inguinoscrotal/inguinolabial hernias. Nearly a third (30.4%) presented after 72hours of complications. At presentation, all (540,100.0%) had irreducible groin swellings and abdominal pain, but 68.95 had abdominal swelling. Comorbidities were present in 26.3% of patients. Strangulation, obstruction and incarceration were present in 46.5%, 42.0% and 11.5% respectively. Morbidity was increased in cases of laparotomy and bowel resection(p=0.000), emergency repair (p<0.001), large hernias (p=0.004) and operations performed by lower rank of surgeon (p=0.001). Bowel resection rate was 28.5%. Overall, morbidity and mortality rates were 47.4% and 8.1% respectively. Mortality was significantly higher in patients with delayed presentation > 24hours (OR:13.42;C.I:6.74-29.44;p=0.001), strangulated cases (OR:3.34;C.I:2.85-11.16;p=0.02), comorbidity (OR:6.72;C.I:10.42-37.55;p=0.01) and advanced age (OR:14.38;C.I:13.46-47.72;p=0.03).

Conclusions: Majority of the patients had voluminous hernias and presented late with attendant high morbidity and mortality. Bowel resection, delayed presentation, advanced age, comorbidity and lower rank of surgeon executing the repair were responsible for high adverse postoperative outcomes.

Peroral extrusion of a ventriculoperitoneal shunt in an infant managed at a tertiary hospital in Lagos, Nigeria

2024-04-24T09:14:42+00:00

[Accepted Case Report]

Ventriculoperitoneal (VP) shunts are commonly employed in the surgical treatment of hydrocephalus despite the expanding frontiers of neuroendoscopy. The risk of VP shunt failure is highest in the first year and is estimated to be between 11% and 25%. VP shunt- related morbidities may occur and these include rare complications such as gastrointestinal perforation by the shunt hardware and extrusion through natural orifices. We report the case of an 11-month-old male who presented five months post-VP shunt insertion with extrusion of the VP shunt hardware through the mouth. We discuss the presentation, investigations, management, and review relevant literature.

Abstracts of the College of Surgeons of East, Central and Southern Africa (COSECSA) 23rd Scientific Conference

2024-04-29T12:36:56+00:00

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Conference abstracts