RISK FACTORS FOR READMISSION AND LENGTH OF INPATIENT STAY IN RURAL GHANA FOLLOWING EXPLORATORY LAPAROTOMY
Hendriksen BS1*, Morrell D1, Keeney L1, Candela X2, Oh J1, Hollenbeak CS1,3,4, Arkorful TE5, Newton C5, Amponsah-Manu F1,5.
1Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
2Penn State College of Medicine, Hershey, PA, USA
3Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
4Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
5Department of Surgery, Eastern Regional Hospital, Koforidua, Ghana
Funding DisclosureNone
Conflict of interest: None
*Corresponding Author:
Brandon S. Hendriksen, MD
Penn State Health Milton S. Hershey Medical Center, Department of Surgery
500 University Drive, PO Box 850
Hershey, PA 17033-0850
E-mail: bhendriksen@pennstatehealth.psu.edu
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ABSTRACT
Background: Increased inpatient length of stay (LOS) and readmission represent significant economic burden on patients and families faced with surgical disease in low-middle income countries given limited surgical access, infrastructure, and variable insurance status. Study Aim: Identify risk factors for readmission and inpatient LOS in postoperative care in the Eastern Regional Hospital, Ghana.
Study Design: Retrospective case series. Setting: Eastern Regional Hospital, Koforidua, Ghana. Methods: Data for exploratory laparotomy procedures were obtained from surgical case logs collected at the regional referral hospital in Koforidua, Eastern Region, Ghana from July 2017 to June 2018. This information was combined with the hospital electronic medical records to collect demographic data, laboratory values, and outcomes. Multivariable analyses were used to model LOS and readmission.
Results: The study included 346 exploratory laparotomy procedures (286 adult, 60 pediatric) for various surgical diseases. The overall 30-day readmission rate was 9.2%. Average LOS was 12.0±20.4 days for readmitted patients and 6.7±5.5 days for patients without readmission. Readmitted patients were more likely to have had preoperative anemia (p=0.009), surgical site infection (P=0.001), or a re-laparotomy (p=0.005). Preoperative anemia (OR=3.5 [95% CI 1.54-7.96], p=0.003) and surgical site infection (OR=3.68 [95% CI 1.36-10.00], p=0.011) were associated with increased odds of readmission. Preoperative anemia was also associated with about 3.0 additional inpatient days (p=0.001).
Conclusions: Preoperative anemia and surgical site infections represent risk factors for readmission in rural Ghana. Anemia is also associated with longer LOS. Future interventions aimed at treating anemia and preventing surgical site infections may reduce some of the post-operative burden placed on patients and their families.
Key word: readmission; length of stay; exploratory laparotomy, surgical burden of disease
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