1Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé, Cameroon
2Department of Anaesthesia and intensive care, Sangmélima Reference Hospital, Cameroon
3Department of Anaesthesia and intensive care, Yaoundé Teaching Hospital, Cameroon
4Department of Anaesthesia and intensive care, Yaoundé Gynaeco-Obstetric and Pediatric Hospital, Cameroon
5Department of Anaesthesia and intensive care, Douala General Hospital, Cameroon
6Department of Anaesthesia and intensive care, Yaoundé Central Hospital, Cameroon
Submission: November 30 2021; Published: January 03, 2022
*Corresponding author: Bengono Bengono Roddy Stephan, Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé, Cameroon
How to cite this article: Bengono B R, Jemea B, Amengle A, Mbengono M J, Ndikontar R, et al. Mortality Risk Factors of Emergency Surgery in
002 Adults: A Longitudinal Study. J Anest & Inten care med. 2022; 11(4): 555819. DOI 10.19080/JAICM.2022.11.555819
Background: Emergency surgery is a challenge for the care. The purpose of the study was to study the risk factors for mortality in emergency surgery in adults.
Patients and Methods: It was a longitudinal and prospective study conducted from December 1st, 2017, to April 30th, 2018, in adults operated for a surgical emergency at the Central Hospital of Yaoundé. The variables studied were the operative indication, the operative risk, the anesthesia’s technique, the complications, the risk factors for mortality. These data were analyzed with the Epi info software version 3.5.4 and the logistic regression was done using the Statistical Package for Social Sciences (SPSS) software version 20.0.
Results: We involved 283 patients. Sex-ratio was 0.2. The median age was 30.6 years and extremes of 18 and 83 years. Obstetric and gynecologic surgeries (76.4%) and digestive surgeries (14.8%) were the most frequent. ASA 2 class was the most represented (47.7%). Surgical risk was minor in 78.8% of cases. Intraoperative complications occurred during the maintenance period (77.9%). They were mainly cardiovascular (79.6%). Postoperative complications were predominantly infectious (33.8%). Fourteen deaths were recorded, with a mortality rate of 4.9% and the factors associated with these deaths were age > 65 years (42.9%), ASA class> 2 and the occurrence of complications.
Conclusion: One in 20 patients died during the perioperative period. The risk factors were related to the presence of comorbidities and the anesthesia’s technique. An optimization of the care would improve the management of the surgical emergencies in the adult.
Keywords:Risk Factors; Mortality; Emergency Surgery
The management of surgical emergencies in developing countries is often confronted with socio-economic problems, the clinical condition of the patient, the distance from healthcare facilities, self-medication, the lack of health education, late arrival in hospital structures, lack of medical transport, insufficient technical platform and adequate human resources. It is therefore a real challenge . In sub-Saharan Africa, traumatic emergencies are the most frequent, with a predominance of Road traffic accidents . The mortality rate after emergency surgery in adults remains high . Over 3 million postoperative deaths occur worldwide per year. There are multiple methods for predicting which patients are at high risk of death or complications from surgery . In Cameroon, Ngowé et al.  in 2007, found a mortality of 8.1% with a predominance of trauma . Perioperative mortality depends on the urgency of the surgery, the type of surgery, the patient’s preoperative condition, the time to treatment and the occurrence of complications [6-8]. Scott John et al in the United States reported that a patient undergoing emergency surgery was eight times more likely to die postoperatively than a patient undergoing elective surgery . With a major postoperative
morbidity rate of around 15%, a short-term mortality rate
between 1 and 3%, and a reproducible association between shortterm
morbidity and long-term survival, the impact of surgical
complications on individual patients, healthcare resources, and
society at large is clearly evident . The aim of our study was to
analyze the risk factors for mortality in emergency surgery.
This was a longitudinal and prospective study carried out
from December 1, 2017, to April 30, 2018, in adults operated
for a surgical emergency at the Yaoundé Central Hospital. After
approval from the national ethics committee, was included in
our study, any patient over the age of 18, admitted for emergency
surgery in an operating room at the Yaoundé Central Hospital,
and who have given their consent. The sampling was consecutive.
Recruitment was carried out during the anesthetic consultation.
The data recorded were the age, the sex, the past history, the
operative risk (surgical and anesthetic), the operative indication,
the anesthesia technique, the ASA, Altemeier and Boersma
classifications. During the intraoperative period, in the operating
room, the monitoring parameters (BP, HR, RR, SpO2), the duration
of anesthesia, the duration of the surgery, the operative procedure
and the intraoperative complications were noted.
The postoperative phase was evaluated in the hospital
wards and in the intensive care unit. The data collected were the
parameters vital signs (BP, HR, RR, SpO2, state of consciousness,
temperature), postoperative complications. Postoperative followup
continued until the 30th postoperative day. The variables
studied were the operative indication, the operative risk, the
anesthesia’s technique, the operative complications, the mortality and risk factors for mortality. Early postoperative complications
occurred within 6 hours of the operation. Late postoperative
complications occurred beyond the first six hours. The data
collected was entered, coded and analyzed using Epi info 3.5.4
version 2012. The continuous variables were expressed as mean
with the standard deviation. Categorical variables were expressed
by frequencies and proportions. The search for associated factors
was performed by multivariate logistic regression analysis using
Statistical Package for Social Sciences version 20.0 software (IBM
Corp. Released 2013. IBM SPSS Statistics for Windows, Version
23.0 Armonk, NY: IBM Corp). This logistic regression model was
able to determine factors associated with death and a p value
<0.05 was considered statistically significant. The study was
conducted in accordance with the basic principles of the Helsinki
Declaration on research involving individuals.
The sample size was 283 patients. The median age was 30.6
years with extremes of 18 and 83 years. The most represented
age group was 18 to 29 (n = 160, 56.5%). The sex-ratio was 0.2.
ASA 1 and 2 classes represented 90.5% of the workforce (n =
256). The average time to take charge was 265.5 minutes, or
approximately 4h 43 minutes, with extremes of 8 minutes to 5
days. General anesthesia was the predominant technique (n = 144,
50.9%). Intraoperative complications were found in 61 patients
(21.6%). Intraoperative complications mainly occurred during the
maintenance period (n=141, 77.9%). They were cardiovascular
(n= 144, 79.6%). Postoperative complications were predominantly
infectious (n=27, 33.8%). The mortality rate was 4.9% (n = 14).
Infection was the most common cause (n = 6, 42.9%). The factors
associated with these deaths were age > 65 years (42.9%), ASA
class > 2 and occurrence of complications (Table 1-5).
The study involved 283 patients predominantly female.
The median age was 30.6 years. ASA classes 1 and 2 accounted
for 90.5% of the cases. The surgical risk was minor (78.8%).
Intraoperative complications occurred during the maintenance
period (77.9%). They were mainly cardiovascular (79.6%).
Postoperative complications were predominantly infectious
(33.8%). The death rate was 4.9%, or 14 deaths. Factors
associated with mortality were age>65 years, ASA class >2 and
occurrence of complications. The preoperative data revealed a
young population, the majority ASA 1 and 2 classes and a minor
surgical risk. This was linked to the mapping of the Cameroonian
population. This was a young population with few comorbidities.
This was confirmed by others Cameroonian series. Ngowé et al
found a mean age of 32.5 years . Owono et al. found a minor
(46.6%) and intermediate (53.4%) surgical risk in his sample
. General anesthesia was the predominant technique (50.9%).
This is the technique most practiced in our context, specifically
during emergency surgery. General anesthesia remains the safest
emergency anesthetic technique even though it is responsible
for many respiratory disorders . Emergency general surgery
is characterized by a comorbid, physiologically acute patient
population with disparately high rates of perioperative morbidity
and mortality . The average time to take charge was 4
hours with extremes of 8 minutes to 5 days. It depended on the
surgical indication and the socio-economic conditions of the
patient. Ngowé et al. in Cameroon, found similar results . The
rate of occurrence of perioperative complications was high. The
intraoperative complications were mainly cardiovascular. Late
postoperative complications were infectious. This was linked to
the socio-economic conditions and the non-optimal conditions
of care. The surgical management of emergencies in emerging
countries is very often confronted with socio-economic problems,
the clinical condition of the patient, the remoteness of care
structures, self-medication, lack of education. health, late arrival
in hospital structures, lack of medical transport, insufficient
technical platform and insufficient medical and paramedical staff
. The death rate was 4.9%. The main causes were infectious.
This mortality depended on the operative indications, the
preoperative preparation and the delay in treatment. These results
were similar to those of several African series. The mortality rate
after emergency surgery in adults remains high. A study carried
out in Madagascar in 2016 revealed a mortality rate of 4.4% .
In Senegal in 2006, Gaye et al found a mortality of 4.3% . Scott John et al reported that a patient who received emergency surgery
was eight times more likely to die postoperatively than a patient
who received elective surgery . The main causes of death are
linked to multiple traumas, time to treatment and the presence of
septic shock [5,13,14]. Over 3 million postoperative deaths occur
worldwide per year. Some of these may be avoidable through
risk-assessment–based modification of treatment pathways, such
as postoperative critical care admission . Mortality rate for
patients undergoing non cardiac surgery in Europe-based on the
European Surgical Outcomes Study-is 4% with crude mortality
rates varying widely between countries (ranging from 1.2% to
21.5%). By comparison, emergency surgery has poorer outcomes
and a higher mortality rate with recent studies reporting the 30-
day mortality to be between 14 and 15% . Factors associated
with mortality were age>65 years, ASA class>2 and occurrence of
These results were linked to the anesthetic risk (ASA
classification), the support delay and the low socio-economic
status. These results are similar to those obtained in several studies
[1,5,16]. Perioperative mortality depends on the emergency of the
surgery, the type of surgery, the patient’s preoperative condition,
the time to treatment and the occurrence of intra and postoperative
complications [6-8]. Analysis of the patients who died within three
days of surgery showed an older age, a higher P-POSSUM, lactate,
and ASA grade, and they were more physiologically compromised,
with a lower systolic blood pressure, raised creatinine, and raised
heart rate . Increasing evidence suggests that postoperative
mortality in both high and low/middle-income settings is due less
to what happens in the operating theatre and more to our ‘failure
to rescue’ patients who develop postoperative complications
. Preoperative risk prediction is important for guiding
clinical decision-making and resource allocation. Clinicians
frequently rely solely on their own clinical judgement for risk
prediction rather than objective measures. The combination of
subjective assessment with a parsimonious risk model improved
perioperative risk estimation . Emergency surgery outcomes
in the UK were worse than those seen in the USA, suggesting
an 8-fold increase in mortality in patients who had a predicted
mortality rate of 0-5%. The report suggested that the differences
could be overcome by better identification of high-risk patients;
improved triage and preassessment; better intraoperative care;
and improved postoperative care, including increased use of
critical care . Risk stratification tools facilitate a meaningful
comparison of surgical outcomes between surgeons, hospitals and healthcare systems. In the perioperative setting, risk stratification
tool can help to objectify the clinical triage process and to quantify
probability of serious morbidity and mortality. Such tools can thus
support surgical decision making and can aid in the informed
The provision of safe surgery is an international healthcare
priority. Guidelines recommend that preoperative risk estimation
should guide treatment decisions and facilitate shared decisionmaking
. The study presented certain limits, like the short
duration of the data collection period. It had as a corollary a
small sample size. This was different from the characteristics of
the other studies. It was also a monocentric study. All this did not
allow us to generalize our results at the national level.
One in 20 patients died during the perioperative period. The
risk factors were related to the operative risk and the anesthesia’s
technique. An optimization of the care would improve the
management of the surgical emergencies in the adult. There is a
need to accurately stratify patient risk so as to make the most of
limited resources and improve perioperative outcomes
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