Digestive Surgical Emergencies and Septic States at the Joseph Ravoahangy Andrianavalona University Hospital in Antananarivo: Epidemiological, Clinical, Therapeutic and Evolutionary Profiles

Njatomalala TNAS¹*, Randriaminomanana F¹, Rakotondrainibe A² and Rakotoarison RCN^1
1Surgical Emergency Department of CHUJRA
²Surgical Resuscitation Service of CHUJRA
*Corresponding Author: Njatomalala TNAS, Surgical Emergency Department of CHUJRA.

Published: May 26, 2023

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Abstract  

Background: Septic states (sepsis and septic shock) remain serious because they are lead to high mortality. Digestive origins are the second cause of sepsis and septic shock in the world.

Aim: To describe the epidemiological, clinical and evolutionary profile of septic states during perioperative emergency digestive surgery at the CHU-JRA.

Method: In a retrospective study, over a period of 36 months (January 2019 to December 2021), all patients over the age of 18, undergoing emergency digestive surgery, presenting with a septic state (perioperatively) were included. Excel® v2211software was used for data processing.

Results: Seventy patients were included, aged 41 [18-80] years, mostly men (sex ratio 1,7). Acute intestinal obstruction represented 52% (n= 42). The qSOFA score was used. The time to progression of the disease (from the appearance of the first signs until the date of consultation and admission to the emergency room) was less than 7 days in 46 patients. Firty-four patients were operated in less than six hours. Sixty patients were treated with dual antibiotic therapy, and 44 patients benefited of norepinephrine (0,3 [0,1-0,5] µg/kg/min) for 2 [1-3] days. On leaving the surgical emergency unit, 21 patients (27%) died of a state of septic shock.

Conclusion: Septic states are frequent in the perioperative of emergency digestive surgeries. Early diagnosis as well as rapid management are the criteria for a good evolution. An improvement in the quality of care is therefore necessary.

Keywords: Digestive system surgical procedure; Mortality; Sepsis; Septic shock; q-SOFA