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Session: ePoster Monitor 3-Colon Cancer 8

eP137 - Perioperative Outcomes After Abdominal Colorectal Surgery at a National Referral Hospital in Tanzania

Monday, June 3, 2024
1:45 PM – 1:50 PM ET, USA
Location: Baltimore Convention Center, Room 318-320

    Author(s)

  • NB

    Nathan Brand, MD, MSc

    Resident
    University of California, San Francisco
    Ucsf
    San Francisco, CA, United States

    Disclosure information not submitted.

    • Author(s)

  • LA

    Larry Onyango Akoko, n/a

    Surgical Oncologist
    MUHAS
    Dar es Salaam, Dar es Salaam, Tanzania

    Disclosure information not submitted.

  • OE

    Obedi M. Emmanuel, MD

    Research associate
    Muhimbili university of health and allied sciences
    Dar es salaam, Dar es Salaam, Tanzania

    Disclosure information not submitted.

  • NK

    Nashivai E. Kivuyo, DR.

    LECTURER, SURGEON
    Muhimbili University of Health and Allied Sciences
    Dar es Salaam, Dar es Salaam, Tanzania

    Disclosure information not submitted.

  • AM

    Ally Mwanga, MD, MMED General Surgery, MSc Surgical Gastroenterologist and HPB Surgeon

    Chairman department of Surgery
    Muhimbili University of Health and Allied Sciences
    DAR ES SALAAM, Dar es Salaam, Tanzania

    Disclosure information not submitted.

    • ePoster Presenter(s)

  • Ann Lowry, MD (she/her/hers)

    Adjunct Professor of Surgery
    University of Minnesota
    University of Minnesota
    Minnetonka, MN, United States

    All relevant financial disclosures have been managed and will be listed below.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • MB

    Marissa A. Boeck, MD, MPH, FACS

    Assistant Professor of Surgery
    University of California, San Francisco/Zuckerberg San Francisco General Hospital
    San Francisco, California, United States

    Disclosure information not submitted.

Purpose/Background: Surgery remains an important intervention for both benign and malignant colorectal diseases. The incidence of both of these disease entities are rising in sub-Saharan Africa, driving an increased demand for colorectal surgeries. Thus, an understanding of overall outcomes and predictors of adverse events is crucial to enhance patient care and surgical practices in the region.Methods/Interventions: We conducted an observational prospective study from August 1st, 2022-July 31st, 2023 that aimed to assess the indications for surgery and outcomes of patients undergoing laparotomy at Muhimbili National Hospital (MNH), the national referral hospital in Tanzania. All patients > 18 years old undergoing laparotomy who could consent were enrolled and data was collected both during their index hospital stay and 30 days post operatively via mobile phone. Data was analyzed using descriptive statistics, Wilcoxon rank sum, chi2, and logistic regression analysis.Results/Outcomes: In total, 581 patients were enrolled in the study; 23 (4%) were lost to follow up at 30 days. Of the 558 patients with complete records, 163 (29%) underwent colon surgery. Cancer was diagnosed in 100 (61%) of these patients and 63 (39%) were operated on for a benign disease process. Of the cancer patients, 67 (67%) had colon cancer, 31 (31%) had rectal cancer, and 3 (3%) had cancer of another source involving the colon. The three most common benign diagnoses were redundant colon 19 (30%), sigmoid volvulus 18 (29%), and anastomotic leak, enterocutaneous fistula, or missed colon injury 10 (16%). Overall, 43 (26%) of colorectal surgery patients died during the study, 27 (17%) were readmitted, and 49 (30%) developed a postoperative complication. The timing of mortality was 18 (42%) during the index hospitalization, 6 (14%) upon readmission, and 19 (44%) at home within a month of discharge. Multivariate logistic regression showed emergency surgery, a cancer diagnosis, or pre-operative sepsis were all independent risk factors for death (Table 1). At 30 days after discharge, of the 97 (59%) patients who were alive and were noted to be working pre-operatively, only 8 (8%) were able to return to work, and 43 (44%) were unable to pay basic bills such as food and housing.Conclusion/

Discussion: In this prospective study of patients undergoing major colorectal surgery at MNH we identify a cancer diagnosis, emergency surgery, and presenting with sepsis as independent risk factors for death within 30 days of discharge. Among those that survive, less than 10% were able to return to work within 30 days and over 40% were unable to pay for basic goods and services one month after discharge. These data highlight both the need to improve clinical outcomes among those requiring colorectal surgery in Tanzania, as well as the significant effect colorectal surgery has on a patient’s ability to work and provide for their families post operatively.Multivariate logistic regression of pre-operative factors on peri-operative survival of patient undergoing colorectal surgery at MNH.