Timing of emergency surgery at the Kenyatta National Hospital
Abstract
Objective: To establish the timing for surgical emergencies at the
Kenyatta National Hospital and review the causes of delay where applicable
Study design: A prospective hospital based study
Study settings: The study was undertaken at KNH in the 12 main
theaters as per inclusion criteria.
Materials and method: Data relevant to the study was collected
including patient's socio-demographic profile and diagnostic workup, arrival
time, theatre notification and time operation began anaesthetist and rank,
surgeon and rank, cause of delay where applicable. The data was recorded in
the data collection tool.
Results and conclusion: About 71.7 % of participants were
subjected to waiting time over 4 hours with the commonest cause being
occupation of theatre with another emergency. All NCEPOD classes were
operated on at all times of the day with no statistical significance between
classes when compared over 24 hours. Emergent cases were done faster than
urgent and scheduled cases but no statistically significant difference was
seen in mean waiting times between urgent and scheduled ·cases. Cases done
within regular working hours experienced statistically significant shorter
mean waiting times than those done after regular working hours. The
presence of a senior surgeon or anaesthetist did not significantly influence
mean waiting time.
Recommendations: Extra theatres need to be set aside for
emergencies including independent orthopaedic and general trauma theatres.
Allocation and prioritisation of emergencies in theatre requires training and
expertise and senior anaesthetists need to be involved. Protocols as laid
down by NCEPOD would be of help in this regard.