The total number of 70 participants was recruited, with predominance of male observed giving a male to female ratio of 4.4:1. The predominance of male sex for general surgical pathology was even documented by other studies(6, 8).The majority were patients aged < 50 years similar to study in Kenya(4).Out of 70 patients, 33(47.1%) developed postoperative complications and 16(22.9%) patients died.
In this study, the major influence of mortality was comorbidity and postoperative complications similar to study in Tanzania (6).
The overall complication in this study was 47.1%. This is consistency to study conducted in neighboring country in Kenya (4). Having similar proportion of complications can be explained due to nature of the clients enrolled in the study who shared common lifestyle. However, other study in middle income countries in India also reported similar findings 36.0%(5). The different can be explained due to early presentation to care and management; in the current study majority of the clients delayed in seeking care in which about 56% of patients presented after 48 hours since the onset of the symptoms, a situation that resulted an increase in risk of complications as reported in this study.
The most reported complications in the current study comprised of septicemia, dyselectrolemia, surgical site infection, enterocutaneous fistula, re-operation and burst abdomen. The nature of complications in this study is almost similar to that reported in Pakistan, India and Kenya (3–5). This implies that varieties of complications due to peritonitis after operation may not be influenced by environmental exposures or ethnicity rather the patient’s altitude and the quality of care that may help to reduce the magnitude of the pertained problem.
In regards to mortality; we found the mortality rate of 22.9%. This was high when compared to other studies in Tanzania(6) and India (9) which reported the overall mortality of 15.46% and 10% respectively. This difference could be explained by the presence of well-equipped established modern accident and emergency department in the study centers as reported by the previous studies where emergency service is provided. Our finding is consistency with other studies in India which found mortality of 25%(8).
Higher complications and mortality in the current study could be explained by late presentation to the health facility by majority of patients and presence of co-morbid illness, a situation which further complicates effective management. In this study, patients with preoperative duration of symptoms for more than 48 hours had increased risk of complications compared to the counterpart. Similarly, studies in India and Tanzania which found that majority of patients who presented late in care were more likely to increase risk of complications(6, 9). Ideally, patients who delayed in presentation for treatment fared the worst, a situation which further complicates effective management.
The current study found the time of surgery was associated with complications. The complications were significantly high in the group of patients where surgery lasted more than 2 hours, and this was statistically significant similar to the finding India (5).
In this study, preoperative serum Potassium levels had affected the complications. Hypokaelemia of less than 3.8 mmol/L was significantly related to complications contrary to findings by Khan et al,. in India where Potassium levels had no relation at all to complications(5). However, despite the difference in finding between the current and that reported by Khan et al., Potassium is still one of the parameters in the Acute Physiology and Chronic Health Evaluation (APACHE) scoring system to predict the outcome.
The study showed that, age more than 50 years had complications of 26.1%, however, this is contrary to other studies that concluded age more than 50 years is related to high overall complications of 47.1% and 50% like studies done in Kenya and in India respectively(4, 9). But in this study the lower complications in the elderly probably was affected by small number of participants in the elderly group.
This study found other indicators for complications include female 61.5%, high PR 48.6% ,purulent peritoneal fluid 51.2%, GIT perforation 51.3%, gangrenous bowel 71.4% ,TLC (less than 4 × 109/L) 66.7%, sodium less than 135 mmol/L (50%), all these were not statistically significant when compared to previous study done by Khan et al which reported significant association with low Hb 36%,Sodium level less than 135 mmol/L (42.9%) and purulent peritoneal fluid 38.7% (5).
In this study, presence of comorbidity was shown to have a significant effect on the mortality where 44.4% of patients with comorbidity died. A similar influence of comorbidity on the mortality was reported by Mabewa et al., with mortality of 60% (6).This may be due to less attention that is given to comorbidity in the setting of surgical emergency and therefore co-morbidity may be overlooked leading to increased risk of mortality. The current study again found high creatinine, low Hb, high PR and high RR were significantly associated with mortality, corresponding to findings in India (5).
Looking into age of patients, this study showed patients with age less than 30 years was significantly associated with mortality of 25% than elderly group aged > 50 years(15.8%) different from previous study in Karnataka where they found patients aged > 50 years were significantly associated with
mortality(10). The difference in mortality may be explained by small number of participants in elderly group aged > 50 years in the present study.
In this study mortality was also seen in patients with faecal peritoneal soakage and presence of abdominal malignancy, similar to the findings in India (8). However, both findings were not conclusive due to small number of patients with malignancy.