Utility of surgical Apgar score as a predictor of early postoperative major complications and mortality among adult patients following emergency laparotomy in Dar es salaam Regional referral Hospitals, Tanzania.

Simple item page
dc.contributor.authorNg’homango, Mabula E.
dc.date.accessioned2026-03-05T10:00:27Z
dc.date.available2026-03-05T10:00:27Z
dc.date.issued2025
dc.descriptionA dissertation submitted as partial fulfillment of the requirements for the Master of Medicine (surgery) degree at Kairuki university
dc.description.abstractBackground: Globally, laparotomy poses adverse postoperative outcomes and mortality. Early postoperative risk stratification to identify patients at risk is important so as to provide better postoperative outcomes and clinical care. The surgical Apgar score (SAS) is a simple and objective scoring system that can be utilized by a surgeon for a better postoperative decision making. However, the score has not been widely validated in resource-limited settings where it would be most valuable. This study aimed to evaluate the capability of SAS to project early postoperative major complications and 30-day mortality following emergency laparotomy in DRRHs. Methodology: This was a prospective observational follow up study among eligible patients aged 18 years and above undergoing emergency laparotomy at Dar es Salaam Regional Referral Hospitals between April 2025 and July 2025. Intraoperative variables were collected, and post-operative outcomes including major postoperative complications and mortality were followed up till 30 days. SAS was calculated from intraoperative lowest heart rate, lowest MAP and blood loss and patients were categorised into 3 categories namely: low risk (8–10), medium risk (5–7), and high risk (0–4) for the development of major complications. Results: A total of 101 patients were included in the study. Males outnumbered females by a ratio of 1.9: 1. The median age was 48 [IQR, 42-56] years. Overall, major postoperative complication and mortality rates were 60.4% and 15.8%, respectively. The mean SAS score was 5.43. The complication rate was found to be significantly high (71.4%) in the high-risk category (SAS, 0-4)compared to 56.8% in the medium (SAS, 5-7) and 40.0% in the low risk category (8-10) (X2 =25.070, p<0.001). Patients categorized as high-risk group had a 23.8% mortality rate compared to 13.6% and 0.0% in the medium and low risk groups, respectively (X2=40.930, p-value <0.001). SAS had a fair and good discriminatory ability for major postoperative complications and mortality with the area under the curve of 0.725(95% CI, 0.624–0.825) and 0.866 (95% CI 0.735 - 0.996), respectively. According to multivariate logistic regression analysis, co-comorbidities (OR, 3.11[1.11-8.23]; p-value =0.004), ASA score (OR 2.34[1.17-9.11]; p-value = 0.011) and duration of surgery (OR, 7.21[2.73-22.11]; p-value = 0.002) were found to be statistically significantly associated with major post-operative, whereas co-comorbidities (OR, 6.12[2.21-23.11]; p-value =0.003), ASA score > 2 (OR 7.22[2.11-34.21]; p-value = 0.012) and duration of surgery (OR, 2.19[1.17-3.73]; p-value =0.017) were independent factors associated with 30-day mortality. Conclusion: This study demonstrated that low SAS (0-4) is associated with increased risk of developing major complications and/or mortality after emergency laparotomy in our setting. SAS had shown a fair and good discriminatory ability for predicting the risk of developing major postoperative complications and mortality following emergency laparotomy, respectively.
dc.identifier.citationNg’homango, Mabula E. 2025. Utility of surgical Apgar score as a predictor of early postoperative major complications and mortality among adult patients following emergency laparotomy in Dar es salaam regional referral hospitals, Tanzania. a prospective cohort study. Dissertation. Kairuki University
dc.identifier.urihttp://kuir.ku.ac.tz:4000/handle/123456789/1507
dc.language.isoen
dc.publisherKairuki University
dc.subjectpostoperative
dc.subjectsurgical Apgar score
dc.subjectlaparotomy
dc.titleUtility of surgical Apgar score as a predictor of early postoperative major complications and mortality among adult patients following emergency laparotomy in Dar es salaam Regional referral Hospitals, Tanzania.
dc.title.alternativea prospective cohort study
dc.typeThesis

Files

Original bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
CORRECTIONS DISSERTAION - MABULA.pdf
Size:
2.97 MB
Format:
Adobe Portable Document Format
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download

Collections

Theses and Dissertations

Total Collections: 1