A clinical survey of nutritional status in surgical patients undergoing laparotomy and its impact on postoperative outcome in Mulago Hospital.
Abstract
Description
A thesis submitted in partial fulfillment of the requirements for the award of the Masters of Medicine in Surgery Degree of Makerere University.
Introduction: The study was based on the observations that many hospitalized patients gave a history of weight loss and the clinically wasted patients were associated with complications such as; prolong& hospital stay, surgical wound infections and deaths. The objectives of the study were to demonstrate an association between pre-operative undernutrition and surgical-outcomes. Methodology: This was a descriptive study done in the surgical wards of Mulago hospital, over a period of three months. A total of one hundred thirty six (136) cases that underwent laparotomy were recruited. The patients' nutritional status were assessed preoperatively using serum albumin; total lymphocyte count and body mass index and their post-operative outcome evaluated using parameters of length of hospital stay; wound infection and mortality. Results: The prevalence of undernutrition according to the different variables was; serum albumin (87%); Total lymphocyte count (50%) and body mass index (15%). There were associations between undernutrition and surgical outcome. There was statistically significant influence of undernutrition on ALOS (p-value of 0.001) and wound infection (p value of 0.021) but was not with mortality (p value of 0.469). Undernutrition predicted the outcomes of laparotomies with the following accuracies: ALOS (33.3%); wound infection (70.2%) and mortality (0.0%) Conclusion: The study demonstrated that undernutrition was prevalent in preoperative patients, though majority had had mild forms of undernutrition. Undernutrition had more influence on wound infection than on length of hospital stay and none on modality. It predicted outcome with the following accuracies: ALOS (33.3%), wound infection (70.2%) and mortality (0%).
Introduction: The study was based on the observations that many hospitalized patients gave a history of weight loss and the clinically wasted patients were associated with complications such as; prolong& hospital stay, surgical wound infections and deaths. The objectives of the study were to demonstrate an association between pre-operative undernutrition and surgical-outcomes. Methodology: This was a descriptive study done in the surgical wards of Mulago hospital, over a period of three months. A total of one hundred thirty six (136) cases that underwent laparotomy were recruited. The patients' nutritional status were assessed preoperatively using serum albumin; total lymphocyte count and body mass index and their post-operative outcome evaluated using parameters of length of hospital stay; wound infection and mortality. Results: The prevalence of undernutrition according to the different variables was; serum albumin (87%); Total lymphocyte count (50%) and body mass index (15%). There were associations between undernutrition and surgical outcome. There was statistically significant influence of undernutrition on ALOS (p-value of 0.001) and wound infection (p value of 0.021) but was not with mortality (p value of 0.469). Undernutrition predicted the outcomes of laparotomies with the following accuracies: ALOS (33.3%); wound infection (70.2%) and mortality (0.0%) Conclusion: The study demonstrated that undernutrition was prevalent in preoperative patients, though majority had had mild forms of undernutrition. Undernutrition had more influence on wound infection than on length of hospital stay and none on modality. It predicted outcome with the following accuracies: ALOS (33.3%), wound infection (70.2%) and mortality (0%).
Keywords
Nutrition, Malnutrition, Laparotomy, Undernutrition, Mulago Hospital, Surgical wounds