Abstract：
BACKGROUND:The burden of emergency general surgery conditions is high in sub-Saharan Africa, and poor access to surgical care leads to poor patient outcomes. We examined the trends in mortality in patients presenting with an acute abdomen to a referral hospital. METHODS:A retrospective analysis of the prospectively collected Kamuzu Central Hospital Acute Care Surgery database was performed (January 2014 to July 2019). Bivariate analysis was conducted by year of admission. A multivariate Poisson regression was performed to identify predictors of mortality. RESULTS:During the study, 2509 patients with acute abdomen presented. The majority of patients presenting were transferred from outside hospitals (n = 2097, 83.9%). Mortality was highest in patients with preoperative diagnosis of peritonitis (n = 119, 22.2%), bowel obstruction (n = 214, 18.7%), and volvuli (n = 51, 18.6%). There was no difference in mortality by year, p = 0.1. On multivariate Poisson regression, there was an increased relative risk of mortality with being transferred (RR 1.31, 95% CI 1.12-1.55, p = 0.002), as well as undergoing an operation within 1-2 days (RR 1.48, 95% CI 1.16-1.87, p < 0.001) and >2 days (RR 1.46, 95% CI 1.17-1.82, p = 0.001) after presentation. CONCLUSION:The majority of patients in our study who presented with an acute abdomen were transferred from district hospitals, which resulted in high mortality due to delays in surgical care. Therefore, the WHO's recommendation that the majority of district hospitals perform the Bellwether procedures does not occur in district hospitals in central Malawi. District hospitals require significant resource investment to reduce transfers needs and patient mortality.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Purcell LN,Robinson B,Msosa V,Gallaher J,Charles Adoi
10.1007/s00268-020-05468-4subject
Has Abstractpub_date
2020-07-01 00:00:00pages
2108-2115issue
7eissn
0364-2313issn
1432-2323pii
10.1007/s00268-020-05468-4journal_volume
44pub_type
杂志文章abstract：PURPOSE:Management of anal fistula represents a balance between curing the condition and maintaining anal continence. Recent reports of the results of the porcine anal fistula plug have demonstrated excellent fistula healing rates without reporting significant complications. METHODS:The outcome of patients who underwe...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-008-9504-1
更新日期：2008-06-01 00:00:00
abstract：BACKGROUND:Significant barriers limit the safe and timely provision of surgical and anaesthetic care in low- and middle-income countries. Nearly one-half of Mongolia's population resides in rural areas where the austere geography makes travel for adequate surgical care very difficult. Our goal was to characterize the a...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-010-0904-7
更新日期：2011-02-01 00:00:00
abstract：:The expression of Fas ligand on tumor cells may counterattack the host's immunity and worsen the prognosis. Knowledge of the prognostic impact of Fas ligand on patients with hepatocellular carcinoma (HCC) after hepatectomy is still limited. Fas ligand expression in HCCs was examined in 59 patients who underwent hepate...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-004-7254-2
更新日期：2004-08-01 00:00:00
abstract：:This study was first designed to investigate systematically the kinetics of surface expression of scavenger receptors (SRs) and CD14 on alveolar macrophages in vivo and in vitro and their relation with local pro- and antiinflammatory responses in endotoxemia. The expression of SR and CD14 in lungs was down- and up-reg...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-002-6548-5
更新日期：2003-01-01 00:00:00
abstract：:This article surveys in an interdisciplinary fashion the evolution of ancient Greek medicine and traumatology in particular. In sounding out the key methods and themes of Greek medicine, we cite a range of medical treatises and correlate them to the rich evidence of ancient Greek art (iconography), which often is expl...
journal_title：World journal of surgery
pub_type： 历史文章,杂志文章
doi：10.1007/s00268-003-6931-x
更新日期：2004-04-01 00:00:00
abstract：:Some 25%-70% of sporadic medullary thyroid carcinomas (MTCs) are associated with somatic mutations within the RET proto-oncogene. In a significant number of MTCs, however, no such genetic variations can be detected, which implies alternative pathogenic molecular alterations. To assess altered RET mutation-specific gen...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-004-7748-y
更新日期：2005-04-01 00:00:00
abstract：BACKGROUND:The pancreatic fistula rate following distal pancreatectomy ranges widely, from 13.3 to 64.0 %. The optimal closure method of the pancreatic remnant remains controversial, especially regarding whether to use a stapler. METHODS:All patients who underwent distal pancreatectomy in five Japanese hospitals from ...
journal_title：World journal of surgery
pub_type： 杂志文章,多中心研究
doi：10.1007/s00268-012-1595-z
更新日期：2012-08-01 00:00:00
abstract：:From January, 1972 to June, 1989, 51 patients with liver hemangiomas (32 females and 19 males, mean age 35 years) were evaluated for surgical treatment. Diameters of the masses were 5 cm to 20 cm (median 8.5 cm). Nine of the patients had already been treated for cancer. Twenty-two (43.1%) of the 51 patients were sympt...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/BF02104457
更新日期：1992-05-01 00:00:00
abstract：BACKGROUND:LLR is widely adapted for HCC, while LLR in PS segments is still challenging. With recent improvement of techniques and accumulation of experiences, LLR in PS segments is feasible, but studies investigating the result after the modifications are lacking. METHODS:In this single-center, retrospective study, 1...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-020-05912-5
更新日期：2021-01-13 00:00:00
abstract：:In 1989-90, all 37 lung cancer patients scheduled for surgery underwent transesophageal endoscopic ultrasonography (EUS) for pre-operative detection of hilar and mediastinal lymph node metastases. An electronic ultrasonic fiberscope with a linear array (EPB-503-FS, Machida-Toshiba) was used. Of 380 nodes surgically re...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/BF02067013
更新日期：1992-09-01 00:00:00
abstract：BACKGROUND:Classification of the open abdomen (OA) status is essential for clinical studies on the subject and may help to improve OA therapy. This is a validity and reliability analysis of the OA classification proposed by the World Society of the Abdominal Compartment Syndrome in 2013. METHODS:Prospective data on 11...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-014-2716-7
更新日期：2014-12-01 00:00:00
abstract：INTRODUCTION:Parastomal hernia (PH) is a frequent complication after end-colostomy formation. PH may negatively influence the quality of life in end-colostomy patients. Our study investigates the quality of life and body image (BI) in patients with an end-colostomy. METHODS:We conducted a cross-sectional study of end-...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-015-3107-4
更新日期：2015-10-01 00:00:00
abstract：BACKGROUND:A small remnant liver volume is an important risk factor for posthepatectomy liver failure and can be predicted accurately by computed tomography (CT) volumetry using radiologic image analysis software. Unfortunately, this software is expensive and usually requires support by a radiologist. ImageJ is a freel...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-007-9197-x
更新日期：2007-11-01 00:00:00
abstract：:The current clinical applications of ultrasonography (US) of soft tissue masses are discussed. These include the detection of occult masses, the characterization of palpable masses, tumor surveillance, and US guided percutaneous aspirations/biopsies of soft tissue masses. ...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s002689910036
更新日期：2000-02-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-008-9818-z
更新日期：2009-02-01 00:00:00
abstract：:Thyrotoxicosis is the clinical syndrome that results when tissues are exposed to high levels of circulating thyroid hormones. In most instances thyrotoxicosis is due to hyperthyroidism, a term reserved for disorders characterized by overproduction of thyroid hormones by the thyroid gland. Nevertheless, thyrotoxicosis ...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/s002680010228
更新日期：2000-11-01 00:00:00
abstract：:The epidermal growth factor receptor family consists of four closely related transmembrane receptors: epidermal growth factor receptor (EGF-R), c-erbB-2, c-erbB-3, and c-erbB-4. Overexpression of each receptor may lead to cell transformation and contributes to tumor progression in various malignancies. Although these ...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s002689900616
更新日期：1999-10-01 00:00:00
abstract：BACKGROUND:Geriatric collaborative care models improve postoperative outcomes for older adults. However, there are limited data exploring how preoperative geriatric assessment may affect surgical cancellations. METHODS:This is a single-center retrospective cohort analysis. Patients enrolled in the Perioperative Optimi...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-020-05772-z
更新日期：2021-01-01 00:00:00
abstract：BACKGROUND:Chronic anal fissure (CAF) is a linear split of the anoderm. The minimally invasive management of CAF such as botulinum toxin (BT) injection is recommended. However, the exact efficient dose of BT, number of injections per session and the injection sites are still debatable. The aim of this analysis was to a...
journal_title：World journal of surgery
pub_type： 杂志文章,meta分析,评审
doi：10.1007/s00268-016-3693-9
更新日期：2016-12-01 00:00:00
abstract：INTRODUCTION:Sentinel lymph node biopsy (SLNB) is the standard of care for staging N0 primary early breast cancers (EBC). Patients in developing countries mostly present with large (LOBC) or locally advanced cancers (LABC) and are treated with neo-adjuvant chemotherapy (NACT). Accuracy of SLNB in staging stage III N0 a...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-015-3222-2
更新日期：2016-07-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-003-7239-6
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-015-3164-8
更新日期：2015-11-01 00:00:00
abstract：BACKGROUND:Scarce data are available on the characteristics of postoperative organ failure (POF) and mortality after gastrectomy. We aimed to describe the causes of organ failure and mortality related to gastrectomy for gastric cancer and to identify patients with POF who are at a risk of failure to rescue (FTR). METH...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-020-05382-9
更新日期：2020-05-01 00:00:00
abstract：BACKGROUND:It has been suggested that gender and age could be factors that influence the likelihood of success following antireflux surgery, and our anecdotal impression has been that the outcome following Nissen fundoplication in older women is often disappointing. If correct, characterization of the extent of any dif...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-009-0216-y
更新日期：2009-12-01 00:00:00
abstract：:The pathogenesis of pain in chronic pancreatitis remains an enigma. The cause of pain is almost certainly multifactorial and may vary at different stages of the disease process. These factors may include the release of excessive oxygen-derived free radicals, tissue hypoxia and acidosis, inflammatory infiltration with ...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/s00268-003-7235-x
更新日期：2003-11-01 00:00:00
abstract：:Precise localization of cervical node metastasis of papillary thyroid carcinoma is rarely described. The aim of this retrospective study was to map their cervical involvement. Between 1974 and 1996 a series of 119 patients had total thyroidectomy with bilateral cervical lymph node dissection. Patients who had secondar...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s002689900609
更新日期：1999-09-01 00:00:00
abstract：BACKGROUND:The most important problem in pancreatic fistula is whether one can distinguish clinical pancreatic fistula, grade B + C fistula by the International Study Group on Pancreatic Fistula (ISGPF), from transient pancreatic fistula (grade A), in the early period after pancreaticoduodenectomy (PD). It remains uncl...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-009-0220-2
更新日期：2009-12-01 00:00:00
abstract：BACKGROUND:Surgical disease burden falls disproportionately on individuals in low- and middle-income countries. These populations are also the least likely to have access to surgical care. Understanding the barriers to access in these populations is therefore necessary to meet the global surgical need. METHODS:Using g...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-016-3765-x
更新日期：2017-03-01 00:00:00
abstract：:Neoadjuvant therapy for locally advanced breast cancer improves disease control, but the complications of treatment are not well established. The aim of this study was to assess the operative morbidity in 20 consecutive patients with locally advanced, noninflammatory breast cancer treated with preoperative chemotherap...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/BF01658934
更新日期：1993-03-01 00:00:00
abstract：BACKGROUND:Open surgical cricopharyngeal myotomy(CM) is considered standard of care for Zenker's diverticulum(ZD). Trans-oral CM has been described using a rigid stapling device for two decades; however, this remains problematic for severely kyphotic patients. This problem can be overcome with flexible endoscopy utiliz...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-016-3442-0
更新日期：2016-06-01 00:00:00
