The Incidence, Risk Factors, and Outcomes of Relaparotomy in the General Surgery Wards at Kenyatta National Hospital

Abstract

Background Relaparotomy is defined as any abdominal operation that is performed following a primary laparatomy, often within 60 days. It is linked to high morbidity and mortality rates reflecting potential quality of care issues like prolonged duration of hospital stay, admissions to the intensive care unit, and increased mortality rates. Objectives The objective of the study was to establish the incidence, associated risk factors, and outcomes of relaparotomy in the general surgery wards at Kenyatta National Hospital. Methods This research applied the retrospective cohort study design. The study duration was January 2020 to December 31, 2021. All patients above 13 years who had undergone laparotomy were included and all the patients who underwent mini laparotomies e.g. during stoma reversal were excluded. The medical records were reviewed for demographics, preoperative parameters, intraoperative findings, and postoperative outcomes. Data were analyzed using SPSS 26 with univariate and multivariable logistic regression, and Chi-square tests for associations. Statistical significance was defined as a p-value of less than 0.05. Results The study enrolled 228 patients, the incidence was 21% (50 patients). The average age was 32.0 years, with a male predominance of 73.2%. The primary indications for relaparotomy were peritoneal collection (34.0%), anastomotic leak (26.0%), and burst abdomen (14.0%). The significant risk factors for relaparatomy included ASA class II, contaminated wounds, surgeon grade, history of alcohol intake, age at admission, presence of a comorbidity, tachycardia, body temperature, hypotension, mechanical ventilation, admission to ICU, presence of a complication, bowel resection, and appendectomy. The complication rates were higher among relaparotomy cases (72% vs 22.1%). A higher proportion of patients who underwent relaparotomy were admitted to the ICU (36.0% vs 2.4%), had longer ICU stay (6.5 vs 4.0days), and had a longer hospital stay (20 days vs 7 days). The overall mortality was 6.6%. Mortality rates were higher in the relaparotomy group (26.0% vs 1.1%). Conclusion The incidence of relaparatomy is 21% in our setting. We must accurately identify patient risk factors, adhere to best practices during the procedure and provide thorough postoperative care in order to minimize the morbidity and mortality rates associated with relaparotomy