Magnitude and associated factors of poor surgical treatment outcomes of bowel obstruction in Ethiopia: A systematic review and meta-analysis
Addisu Simachew Asgai, Jenberu Mekurianew Kelkay, Tsegaamlak Kumelachew Derse, Demeke Shumu Negesse, Tilahun Bitew, Alemnew wale Tegegne, Tadios Lidetu, Desalegn Mitiku KidieIntroduction
Bowel obstruction is a major surgical emergency associated with considerable postoperative morbidity and mortality, particularly in low-resource settings. Evidence on surgical outcomes in Ethiopia remains inconsistent. This systematic review and meta-analysis aimed to estimate the pooled magnitude of poor surgical treatment outcomes of bowel obstruction and identify associated factors.
Methods
A comprehensive search of PubMed, Cochrane Library, HINARI, AJOL, and google scholar was conducted. Observational studies reporting surgical outcomes among Ethiopian patients with bowel obstruction were included. Poor surgical outcomes were identified as postoperative complications and/or death in the hospital. A random effect meta-analysis model was used to calculate pooled prevalence and pooled odds ratios with 95% confidence intervals. Heterogeneity and publication bias were assessed using standard statistical methods.
Result
Twenty-one studies comprising 5,429 patients were included. The pooled prevalence of poor surgical treatment outcomes in Ethiopia was 24% (95% CI: 19%-28%), with substantial heterogeneity (I 2 =93.6%). Delayed hospital presentation (>=24hours) (OR=2.2; 95% CI: 1.52-3.24), hospital stay >7 days (OR=2.37; 95%CI 1.72-3.25), and undergoing resection and anastomosis (OR=3.35; 95% CI: 2.07-5.4) were significantly associated with poor outcomes.
Conclusion and recommendations
The prevalence of poor surgical treatment outcomes of bowel obstruction in Ethiopia was relatively high. Early presentation, timely intervention, and strengthening perioperative care are critical to improving surgical outcomes.