ArticleBMC surgery2025
Determinants of surgical management outcomes among adult patients with intestinal obstruction at Mzuzu central hospital, Malawi.
Article in BMC surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionIntestinal obstruction causes significant morbidity and mortality worldwide, particularly in low-resource settings. Understanding factors influencing surgical outcomes is crucial for improving patient care. This study aimed to assess the determinants of surgical management outcomes among adult patients with intestinal obstruction at Mzuzu Central Hospital, Malawi.
methodsThis retrospective cross-sectional study included 262 adult patients diagnosed with intestinal obstruction between July 2021 and June 2024. Data were collected through patient chart reviews, focusing on demographic characteristics, care- and disease-related factors, and outcomes of surgical management (death and discharge). Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 22. Descriptive statistics were used to summarise patient characteristics, and multivariable logistic regression analysis was conducted to identify predictors of surgical outcomes, with statistical significance set at p ≤ 0.05.
resultsThe mean age of the patients was 46.6 ± 19.2 years (range, 15–94 years). The overall mortality rate was 39(14.9%), whereas 223(85.1%) were successfully discharged, and 30(16.2%) developed wound infections. The average duration of illness before admission was 5.0 ± 7.5 days, and the average hospital stay was 10.6 ± 9.3 days. Most patients, 138(52.7%), presented with small bowel obstruction, predominantly due to adhesions, 63(24.0%) and viable small intestinal volvulus, 24(9.3%). Among patients with large bowel obstruction, the leading causes were viable sigmoid volvulus, 39(14.1%) and gangrenous sigmoid volvulus, 28(10.7%). In the bivariate analysis, variables such as age, ASA score, malaria test results, haemoglobin levels, preoperative sepsis, and abdominal distension had p-values < 0.25 and were therefore included in the multivariable logistic regression model. After adjustment, only ASA score ≥ III [AOR = 5.05, 95% CI: 1.86–13.60; p < 0.001] and abdominal distension [AOR = 2.36, 95% CI: 0.99–5.61; p = 0.050] remained independently associated with unfavourable surgical outcomes.
conclusionAn ASA score ≥ III and clinical manifestation of abdominal distension are key determinants of unfavourable surgical management outcomes in patients with intestinal obstruction at Mzuzu Central Hospital. Strengthening perioperative assessment and timely surgical intervention are recommended to enhance the patient outcomes.
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