CLINICAL OUTCOMES AND BARRIERS TO CARE IN ADULT NON-TRAUMA SURGICAL EMERGENCIES: A PROSPECTIVE STUDY AT KISII TEACHING AND REFERRAL HOSPITAL mikenyariki@gmail.com

 

CLINICAL OUTCOMES AND BARRIERS TO CARE IN ADULT NON-TRAUMA SURGICAL EMERGENCIES: A PROSPECTIVE STUDY AT KISII TEACHING AND REFERRAL HOSPITAL

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Kenya

Oral or Poster

Surgical emergencies account for nearly half of all surgical admissions, with delays in intervention often leading to severe morbidity or mortality. In Kenya, timely access to emergency surgical care is constrained by infrastructural, diagnostic, and financial barriers. This study assessed outcomes and management challenges of adult non-trauma surgical emergencies at Kisii Teaching and Referral Hospital (KTRH).

A six-month prospective observational study was conducted among adults (≥18 years) presenting with non-trauma surgical emergencies to the Accident and Emergency Department at KTRH. Consecutive eligible patients were recruited, interviewed using structured questionnaires, and followed until discharge or death. Data were analysed using SPSS after obtaining ethical approval.

Of 186 patients enrolled (mean age 44.3 years; 54% male), acute appendicitis (28%), intestinal obstruction (23%), and perforated peptic ulcer (15%) were most common. The median time from presentation to surgery was 14 hours (IQR: 8–27). In-hospital mortality was 7.5%, highest among patients with perforated viscus (18%). Post-operative complications occurred in 21% of cases, predominantly surgical site infections (11%) and sepsis (6%). Delays in care were attributed to limited theatre capacity, slow diagnostics, late presentation, and financial constraints.

Non-trauma surgical emergencies contribute substantially to the surgical workload at KTRH, with preventable delays contributing to adverse outcomes. Strengthening emergency surgical services through expanded theatre capacity, 24-hour readiness, improved diagnostics, streamlined referrals, standardized protocols, and financial risk protection could reduce morbidity and mortality. Addressing these systemic gaps is essential to improve surgical emergency care in similar resource-limited settings.