Title: Surgical Emergency- A View of a Developing Institute
Authors: Hemchandra Singh Thoudam, T A Singh
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.125
Abstract
Background: Emergency Surgery is continuing event in every sphere of the world
Prevalence of cases, Protocol of diagnosis, intervention, prognosis, and reporting system are variable at different institutes.
The factors are due to topographical, socio-economic and institutional infrastructure
Objective: The objective is to study a current randomise event in a single developing health institute of India and also to compare with the prevailing trend in other developed country institutes.
The study is in a developing health institute of India. It is conducted at J.N. Institute of Medical Sciences, Imphal, Manipur
The continuous study is for a period of 2 years and 9 months from February 2014 to November 2016.
It is also aimed at the overall information from other hospitals along with the post discharge event, and surveillance for updating the institutional status and upliftment of health care delivery system in a region.
Method and Material: All the patients who had undergone emergency operation are considered as subject of study. The cases are from casualty department and indoor ward.
Patients from CTVS, Neurosurgical, Nephrology, Paediatrics, Plastic gastrointestinal surgery are not included in this study.
Operative Procedure: Open operations are the method employed. Laparoscopic and endoscopic procedure are not considered
Investigation: Routine examination of blood, plain X-Ray of chest and abdomen, ultrasonography, CT–Scan, and are the investigations done in regard to these procedures.
Prognosis: It is recorded during hospitalisation and post discharge follow up period of one month.
Post discharge follow up was conducted in Surgery OPD.
In patient mortality information are collected from hospital medical record office.Post discharge mortality figure are obtained from the readmitted cases in the same hospital
Result: Out of the 1168 emergency operations appendectomy contributes 1104 (94.5%).Female preponderance is more than the male and incident rate is highest in the age group of 20 -30 years. It is followed by hollow viscus perforation and intestinal obstruction which is 33(2.8%), 11(0.9%) respectively.
For the rest of the cases numbers are few and occur sporadically. So the figures are not sufficient for observation and result.
The average duration of hospital stay is 3 days
The number of death is 25 (2.84%), out of this 21 cases were in Surgical intensive care unit.
Number of death from Septicaemia is 9(3.6%). This mortality figure is obtained during the hospital stay.
Morbidity rate is measured in terms of prolonged hospital stay and complications.
114(9.7%) Patient had longer hospital stay. The average duration of hospital stay is 3 days. Total number of death from all causes is 25(2.1%).,9(3.6%) death rate were attributable to septicaemia.
Follow up cases were spontaneously turned up group. The total number of reported cases in surgical outpatient department was of 720 (63.2%) within one month period of discharge.
Conclusion: 1168 emergency operations were conducted in this institute Acute appendicitis is the commonest cause of acute abdomen, and emergency appendicectomy is the operative procedure taking place everywhere. Here in this study the female preponderance occurs more frequently. The commonest incidence is found in the age group of 20-30 years. It is followed by hollow viscus perforation and intestinal obstruction respectively. For the rest of the cases the numbers are less for interpreting data. Total number of death is 25(2.1%) 32 cases were found to have associated with SSI, and of which 9 (3.6%) cases are attributable to septicaemia. The follow up information is obtained for surgical OPD and the number of which is 720 (63.2%). Due to the lack of up to date reporting and the surveillance system post discharge events could not be obtained. As a result of which systemic and generalised participation from the community is not well appreciated.
Keywords: Emergency Surgery, Surgery and Institutional status, Surveillance in developing region.
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Hemchandra Singh Thoudam
JNIMS Imphal Manipur