Postoperative mortality and associated factors among children with intestinal obstruction in Mulago National Referral Hospital

Abstract

Introduction: Intestinal obstruction (IO) is a common paediatric surgical emergency worldwide. The incidence of IO is 1 in 2000 live births in newborns and 1 in 5000 in children greater than 2 years of age. The leading cause of intestinal obstruction among children living in high and low middle-income countries is intussusception followed by obstructed hernia. In Uganda the exact prevalence of IO in the paediatric population has not been studied. Mortality due to intestinal obstruction is likely to increase once there is delayed intervention. Objective: To determine the outcomes of children with intestinal obstruction and factors associated postoperative mortality at Mulago National Referral Hospital. Methods: This study was a prospective cohort study. It included 74 children with intestinal obstruction who were followed up for 2 weeks post discharge. Outcome variable included mortality. Data was collected using a semi structured questionnaire, cleaned and entered in Epidata version 3.1 and analyzed using STATA version 14.0. Bivariate and multivariate logistic regression was used to assess association. The factors associated with mortality were computed and expressed as a ratio. Results: Of the 74 study participants, 17(24.6%) died, 5(6.7%) were lost to follow up. The factors associated with mortality included age <12 months were 5.317times more likely to die compared to other age groups and children who had gut perforation were 16.96 times more likely to die post operatively compared with those who did not have. Conclusion and recommendation: Mortality due to intestinal obstruction was high 24.6%. Being <12 months and having gut perforation at surgery is associated with increased likelihood of dying post-surgery. Gut perforation is associated with high mortality thus need to have senior medical personnel at the time of operation and manage these patients in HDU or ICU postoperatively. Need to encourage attendants to seek for medical help immediately and continuous medical education for the primary doctors.