Time to death and predictors of in-hospital mortality among adults underwent emergency abdominal surgery at a tertiary hospital in Ethiopia: a retrospective follow-up study

Abstract Emergency abdominal surgery is burdened by significant mortality and morbidity rates. There is a short window between the time of presentation and the time of surgical intervention which causes an inherent risk of increased perioperative and postoperative morbidity and mortality. This study is aimed at determining the time to in-hospital mortality as well as its predictors in patient who underwent emergency abdominal surgery. Retrospective cohort study was conducted among adult patients who underwent surgery for emergency abdominal conditions from January 1, 2019 to December 30, 2023 at JUMC (Jimma University Medical Center). Three hundred records were selected by systematic random sampling technique. Data were collected using a structured data extraction checklist with Kobo Toolbox by trained data collectors at JUMC. The collected data were exported into STATA Version 17 for analysis. Bivariate Cox regression analysis was conducted to identify candidate variables at p-value < 0.25 for multivariable Cox regression model. Finally, in multivariable Cox-Regression analysis, the p-value < 0.05 and Adjusted Hazard Ratio (AHR) with 95% CI were used to judge statistical significance. 300 medical records of surgical patients with emergency abdominal surgical conditions who underwent surgery during the five-year study period at JUMC were reviewed. Out of the 300 patients, 37 had died in the hospital and the median time of death was 40 days. The overall incidence rate of death was 1.35 (95% CI: 0.98–1.86) per 100 person-days. Being male (AHR = 4.1, 95% CI 1.25–15.42), and older adults (AHR = 7.77, 95% CI 2.57–33.5) had an increased hazard of death. Patients’ American Society of Anesthesiologists grade (AHR = 2.81, 95% CI: 1.2–6.6), shock (AHR = 9.7, 95% CI: 1.8–39.9), surgical site infection (AHR = 0.43, 95% CI 0.23–0.79) and re-laparotomy (AHR = 2.18, 95% CI 1.35–13.6) were significant predictors of time to death. In-hospital mortality among adults undergoing emergency abdominal surgery remained high in our study. The condition of the patient at presentation and postoperative complications were significant predictors of in-hospital mortality. Devising special integrated efforts and guidelines for perioperative management of patients can improve survival outcome and decrease postoperative complications.