Determinants of Surgical Outcomes of Small Intestinal Atresia at Kenyatta National Hospital,kenya

Abstract

Background: Small intestinal atresia is the third most common cause of intestinal obstruction in neonates. Advancements in the perioperative management of these patients have led to better survival rates and outcomes in developed countries, however, such outcomes in the developing countries have not been recorded. Several factors such as age at surgery, associated anomalies, type of atresia, availability of neonatal ICU and Total Parenteral Nutrition, time taken to reach full feeds, have been found to have an influence on the outcome of these patients. The study aimed to establish determinants of surgical outcome of small intestinal atresia at Kenyatta National Hospital. Study objective: To determine the factors that affect surgical outcomes of small intestinal atresia at Kenyatta National Hospital. Study design: A retrospective cross-sectional study Methods: Records of neonates admitted to Kenyatta National Hospital with a diagnosis of small intestinal atresia from January 2014 to October 2020 who fit the inclusion criteria were retrieved. Data on demographics, clinical findings, perioperative findings and outcomes were extracted. Data management and analysis: Data collected was entered into spreadsheets and analyzed using SPSS version 24 software to determine any significant relationships. Data was then summarized into frequencies and percentages for categorical data and mean with standard deviation for continuous data. Factors influencing the surgical outcome were analyzed with Pearson Chi square tests and those with significant associations were subjected to multivariate analysis with use of logistic regression.

Results: 135 patient files were studied. Significant factors which influenced mortality were presence of associated anomalies, type of atresia and use of TPN. The most common complications encountered were anemia, jaundice and sepsis. Mortality was at recorded at 56.3%. Conclusion: The mortality rate seen at KNH is high. Though the factors which have been found to increase the survival rate of SIA in developed countries are available at KNH, they are few and strained to cater for all neonates at KNH. It is recommended to increase the capacity of NICU at KNH and to have CVC inserted so as to facilitate TPN administration. Study utility: The study will pave way for the development of new management protocols that can be practiced at KNH which will lead to improved short and long term outcomes. Information gained from this study will aid in updating healthcare workers at peripheral facilities on pretransfer stabilization and optimization of these neonates.