ArticleWorld journal of surgery2022
Inter-hospital Transfer Delays to a Tertiary Referral Center and Postoperative Outcomes in Patients with Abdominal Surgical Emergencies in Malawi.
Article in World journal of surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed, 1 citations in OpenAlex.
- Identifying delays to emergency laparotomy in a low-resource setting using the Three Delays Model: a prospective observational study (DEL study).BMJ global health · 2026Observational
- Nomogram for predicting massive abdominal bleeding in duodenal fistula patients with uncontrolled abdominal infection after delayed transfer to tertiary centers: a multicenter prospective study.International journal of surgery (London, England) · 2026Article
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Authors and funding
5 authors at 2 institutions in 2 countries.
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Abstract
backgroundIn low-income countries (LICs), patients with abdominal surgical emergencies often initially present to primary or district hospitals and are transferred to referral hospitals for surgical management. The transfer process introduces a delay to care, but the relationship between transfer time and outcomes has not been studied in LICs. We sought to evaluate the effect of transfer delays on postoperative outcomes among patients undergoing emergency abdominal surgery in Malawi.
methodsThis is a retrospective analysis of the acute care surgery database at Kamuzu Central Hospital (KCH), a referral hospital in Malawi. Patients were eligible for inclusion if transferred from another facility to KCH for emergency abdominal surgery. We used logistic regression modeling to evaluate the relationship between transfer time and postoperative complications and mortality.
resultsThe study included 2037 patients. Female patients, patients transferred from district hospitals, and patients with bowel obstructions were most likely to spend over three days at a referring facility before transfer. On regression modeling, each additional day until transfer was associated with an 18% increase in odds of developing a postoperative complication (OR 1.18, 95% CI 1.05-1.31, p = 0.005) and a 19% increase in odds of postoperative mortality (OR 1.19, 95% CI 1.08-1.31, p < 0.001).
conclusionAmong patients requiring emergency abdominal surgery in Malawi, transfer delays are associated with higher postoperative complications and mortality rates. Further research should focus on identifying the factors causing delays so that interventions aimed at improving the transfer process can be developed.
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