Factors Associated with Perioperative Mortality in Typhoid Fever Patients with Intestinal Perforation in Nigeria

Objective: Despite the availability of effective antibiotic treatment, patients in Nigeria continue to perish from complications of typhoid fever, including intestinal perforations. Given the preventable nature of these deaths, we attempted to identify pre-operative factors that may influence mortality in typhoid patients with intestinal perforation at Bowen University Teaching Hospital (BUTH) in Ogbomoso, Nigeria.

Methodology: All the charts of patients with typhoid admitted to BUTH for surgical repair of intestinal perforation were reviewed from January 2004 to March 2009. There were 173 patients treated during that period; however, adequate records were obtained for 144 patients. These were analyzed for statistical associations between patient characteristics and mortality.

Result: There were 32 deaths, yielding a mortality rate of 22.2%. Female gender (p=0.013), presence of neurological symptoms on presentation (0.014), delay in securing blood for patients requiring pre-operative blood transfusion (p=0.028), length of that delay (p=0.037) and duration of presentation-operation time interval (p=0.025) were associated with increased mortality. There was no association between mortality and age, time from symptom onset to hospital presentation or any other sign/symptoms or laboratory values.

Conclusion: Delay in obtaining blood for patients requiring pre-operative transfusion and prolonged duration of presentation-operation interval were the only modifiable factors associated with increased mortality. Efforts to increase blood donation and decrease delay between hospital presentation and operation can ensure that patients with typhoid related intestinal perforations receive proper treatment as quickly as possible.

Author(s): Barnett BS, Tarpley MJ, Davidson MA and Gbadero DA

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