Epidemiological patterns of general surgical emergencies during Hajj pilgrimage: a 10-year retrospective cohort study

Background: The public health challenges of the annual Hajj, one of the world’s largest religious mass gatherings, are well-described. However, data on Hajj-related general surgical (GS) admissions and outcomes remain limited. This single-center study describes the spectrum and burden of emergency general surgery during Hajj and explores demographic associations with admission patterns and outcomes. Materials and Methods: A retrospective single-center cohort study of emergency GS admissions across ten consecutive Hajj seasons (1431–1440 Hijri November 2010–August 2019) was conducted at Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Hospital-based admission patterns, demographic characteristics, disease distribution, and clinical outcomes were recorded. Multivariable logistic regression was used to explore factors associated with mortality and discharge against medical advice (DAMA), adjusting for age, sex, nationality, and disease category. Results: A total of 1929 GS patients were identified (68% male, 32% female). Forty-seven distinct GS diagnoses were recorded. Acute abdominal conditions (43.8%) and septic skin conditions (36.3%) accounted for the majority of admissions. Several demographic and diagnostic factors were associated with admission patterns and outcomes. The overall mortality and DAMA rates were 6.01% (116/1929) and 10.1% (195/1929), respectively. Conclusion: This single-center retrospective cohort study sheds light on the epidemiological patterns of emergency GS admissions during Hajj and identifies demographic and diagnostic factors associated with outcomes. Prospective, multicenter studies with granular severity and process-of-care data are needed before these findings can be extrapolated to other mass-gathering settings.