The magnitude of unfavourable management outcome of IO at Chiro General Hospital was 21.3%. The most unfavourable management outcome of IO was wound site Infection. In current study Old age, late presentation of illness and pre-operative diagnosis of gangrenous bowel were significantly associated with the occurrence of unfavorable management outcome of Intestinal Obstruction.
This is in line with the study done Adama(24.6%)[10] and India (25.89%)[11]. But the magnitude of unfavourable management outcome of IO in this study was low compared with the reported studies done at Canada (64%)[12] and Nigeria(66.5%)[13] . This difference may be the cause of IO and type of procedure done (intussusception was the most cause of IO by which highest R&A was done while R&A was significantly associated with management outcome) a study done at Nigeria. This difference may be different studying population and different mean age a study done in both studies. On the contrary, this magnitude was higher than the study done in Kenya (13.6%)[14]. The possible difference may be residence of a patient in which there were lower proportion of patient came from rural dweller (58.7%)[14] than this study (78%). Patient who came from urban area or area near to hospital have good awareness on the importance of getting health service early, hence early intervention had lower unfavourable outcome. The other possible reason for the difference SOP (Standard of Procedure) may be applied more properly in the study area of Kenya. Following SOP for every procedure decrease the acquisition of microorganism into surgical wound, hence the lower the infectious organism, the lower the magnitude of unfavourable outcome.
The most post-operative complication was wound site infection (hematoma& incisional SSI) 30(55.5%) followed by post-operative pneumonia 08(14.8%), Anastomotic leak 06(11.1%), 05(9.3%) respectively. The most post-operative complication was similar a study done at Adama, Kenya and Nigeria which accounts 39.3%, 33% and 31.4% respectively among patient develop complication [10, 13, 14]. But a study done at Canada the most post-operative complication was respiratory complication like pneumonia [12] which is second complication in this study. This difference may be the lower proportion of malnutrition patient & poor health-seeking behavior and higher standard of life modification style including hygiene in developed nation such as Canada than developing nation such as Ethiopia and other African countries.
Unfavorable outcome of patients with IO was affected by the cause of obstruction, duration of illness, age and complication detection time. [15].
In this study, being old age (age ≥55 years) was nearly 3 times more likely to develop unfavorable management outcome of IO, compared with those patients whose ages less than 55 years. This was in line with a study done Gondar [5]. This study was contradict with a study done in Adama [10],in which age of patients were not significant predictor of unfavourable outcome. This may be due to old age group in study area may came early, hence high proportion of favourable outcome.
Generally outcome of patient with surgically treated for IO might be affected by different factors, such as age of patient, residence of patient, duration of illness, cause of obstruction, viability of bowel, type of procedure done and length of hospital stays.
Duration of illness before surgical intervention has significant statistical association with unfavorable management outcome of patients with IO. Patient who came late were about three times more likely to develop unfavorable management outcome, compared patients who came early. This study was similar a studies done in Adama [10] and Gondar [5], in which patients who came late had higher propotion of poor outcome. This was possibly due to poor health-seeking behavior and poor transportation system in this sub-region. Late presentation in case of intestinal obstruction accounts for disastrous outcomes, notably high rate of complications, long hospital stay and high mortality rates[2].
In this study unfavorable management outcome of patient with IO were significantly affected by intra-operative finding of gangrenous bowel. Patients with gangrenous SBO and gangrenous LBO were more likely to develop unfavorable management outcome of patient with IO, compared with patients with simple SBO. This study was in line with a study done at Adama [10].
In this study gender of the patients did not influence the outcome of treatment in terms of morbidity and mortality. This also same in study done at Adama, Nigeria, Ruanda [10, 13, 16].
In this study unfavorable management outcome were not significantly affected by Intra-operative procedures of bowel resection and anastomosis. This was in contrary with a studies done at Nigeria, Kenya and Adama [10, 13],in which RA were significantly increase the outcome of unfavourable management outcome.
Limitation of the study
· In this study since it was a document review ,some data’s were incomplete, as well poor hand writing in some cards and even few cards were missed.
· It was impossible to measure some essential parameters, which may significantly contribute for Unfavorable outcome of IO like Educational status of the patients, Occupational status, and House hold income per month since, secondary data was utilized in this study.
· There was scarcity of data available in the country, and no similar published data from the region which makes difficult in comparisons of the study.
· The results of the study may not show the actual picture of the problem in the community since this study was a facility based study.
Conclusions
In conclusion, the magnitude of unfavourable management outcome of patients with IO who treated surgically at Chiro General Hospital was high; this can result in significant morbidity and mortality. The common factors associated with unfavourable management outcome of patients with IO who treated surgically were old age, late presentation of illness and gangrenous bowel obstruction. But still magnitude of unfavourable management outcome can be reduced largely through: early detection, fluid resuscitation and electrolyte balance, administration of prophylactic antibiotics prior to operation and properly applying infection prevention protocol and SOP.
Even though, the occurrence of unfavourable management outcome is not preventable but still it can be decreased largely through assessing the risk factors, early recognition and following the standardized management protocol