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Aug 4, 2023Keywords:
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Predictors of post operative outcomes and time to full recovery among first time thoracotomy cases at Tikur Anbessa Specialized Hospital in Ethiopia
Abstract
Background: Thoracotomy is a major surgical procedure requiring a thorough understanding of cardiorespiratory mechanics. Postoperative care requires a high-dependency environment and trained and well-experienced staff. The aim of this study was to determine the post-op outcomes, estimate the time to full post-op recovery, and identify predictors associated with these outcomes among patients who underwent first time thoracotomy at Tikur Anbessa Specialized Hospital (TASH) from April 1, 2011 to March 31, 2012 in Ethiopia.
Methodology: A retrospective chart review was conducted among 148 patients. Descriptive analysis using frequencies with percentages and mean survival times were used to characterize the study population. To compare the mean time to post-thoracotomy recovery between groups, Kaplan-Meier survival plot together with Log-rank test was used. To identify significant predictors of post-thoracotomy outcomes and time to post-thoracotomy recovery, a robust Poisson regression model and Cox proportional hazard survival model were run at 5% level of statistical significance.
Results: From the 148 patients, 115 (77.7%, 95% CI=71.5%-85.6%) fully recovered, 27 (18.2%, 95% CI=12.0%- 23.6%) have recovered with complications and 6 (4.1%, 95% CI=1.4%-6.9%) died. The overall mean time to postthoracotomy recovery was 13.2 days (95% CI=10.1-16.4). Significant predictors of major complications and death were being male (ARR=1.99, 95% CI=1.02, 3.94, p=0.049), pre-op WHO Performance status score of 3 and 4 (ARR=2.56, 95% CI=1.19, 5.48, p=0.015), developing intraoperative complication (ARR=2.29, 95%CI=1.14, 4.59, p=0.020) and taking systemic analgesia (ARR=4.13, 95% CI=1.05, 16.23, p=0.042). Significant predictors of time to post-op recovery were being male (AHR=0.62, 95% CI=0.42,0.92, p=0.017) and developing intraoperative complication (AHR=0.38, 95% CI=0.18, 0.80, p=0.011).
Conclusion: The post-thoracotomy morbidity and mortality in the study population is similar to previous reports, and the mean recovery time is within the expected range for a good outcome. For further improvement in these outcomes, it is crucial to mitigate risks during the preoperative period and closely monitor and manage high-risk patients during the postoperative period.
