Predictors Of Early Management Outcomes In Patients With Dynamic Intestinal Obstruction Operated At Iringa Regional Referral Hospital Southern Highlands Tanzania

ABSTRACT

Background: Intestinal obstruction is one of the most causes of cause of surgical emergency associated with morbidity and mortality in surgical department. The study aimed to determine the causes and predictors of management outcome in postoperative patients with intestinal obstruction at IRRH. Method: A prospective hospital based study design was used. Duration of the study was six months. The collected data were checked for any inconsistency, coded and entered into SPSS version 20 for data processing and analysis. Descriptive and logistic regression analyses were used. Statistical significance was based on confidence interval (CI) of 95 % at a p-value of < 0.05. Result: 59 adult patients were admitted with intestinal obstruction. The morbidity and mortality rates were 18.6% and 6.8% respectively. The most common cause of obstruction was sigmoid volvulus (55.9%) followed by adhesion (37.3%). The major predictors of management outcome of intestinal obstruction were: occupation, mode of referral, etiology bowel status and the procedures done during operation. Categories which were likely to develop poor outcomes in multivariate regression were Peasants (AOR = 0.08; CI =0.02-1.05; P = 0.041). Referred patients (AOR1.9371; CI=0.02-0.244; P-value= 0.026). Volvulus (AOR=2.020; CI=1.13-2.2.45; P– Value = 0.0420). The gangrene bowel (AOR= 0.09; CI = 0.02-0.070; P = 0.020) and colostomy/ ileostomy (AOR=1.202; CI=4.363-3.341: P-value=0.024) hence statistically significant respectively. Conclusion: in this study, sigmoid volvulus is the leading causes of large bowel obstruction. Invasive procedure was done to all patients. Bowel resection and anastomosis was the commonest intra-operative procedure done and is associated with postoperative complications. Wound infection was the most common postoperative complication. vi TABLE