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Inter-hospital Transfer Delays to a Tertiary Referral Center and Postoperative Outcomes in Patients with Abdominal Surgical Emergencies in Malawi

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Abstract

Background

In low-income countries (LICs), patients with abdominal surgical emergencies often initially present to primary or district hospitals and are transferred to referral hospitals for surgical management. The transfer process introduces a delay to care, but the relationship between transfer time and outcomes has not been studied in LICs. We sought to evaluate the effect of transfer delays on postoperative outcomes among patients undergoing emergency abdominal surgery in Malawi.

Methods

This is a retrospective analysis of the acute care surgery database at Kamuzu Central Hospital (KCH), a referral hospital in Malawi. Patients were eligible for inclusion if transferred from another facility to KCH for emergency abdominal surgery. We used logistic regression modeling to evaluate the relationship between transfer time and postoperative complications and mortality.

Results

The study included 2037 patients. Female patients, patients transferred from district hospitals, and patients with bowel obstructions were most likely to spend over three days at a referring facility before transfer. On regression modeling, each additional day until transfer was associated with an 18% increase in odds of developing a postoperative complication (OR 1.18, 95% CI 1.05–1.31, p = 0.005) and a 19% increase in odds of postoperative mortality (OR 1.19, 95% CI 1.08–1.31, p < 0.001).

Conclusion

Among patients requiring emergency abdominal surgery in Malawi, transfer delays are associated with higher postoperative complications and mortality rates. Further research should focus on identifying the factors causing delays so that interventions aimed at improving the transfer process can be developed.

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Funding

This study was supported by the NIH Fogarty International Center (Grant #D43TW009340).

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Authors and Affiliations

  1. Department of Surgery, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, USA

    Avital Yohann, Jared Gallaher & Anthony Charles

  2. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi

    Chifundo Kajombo, Gift Mulima & Anthony Charles

Authors
  1. Avital Yohann
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  2. Chifundo Kajombo
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  3. Gift Mulima
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  4. Jared Gallaher
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  5. Anthony Charles
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Corresponding author

Correspondence to Anthony Charles.

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Conflict of interest

The authors declare that they have no conflict of interest.

Study approval

The University of North Carolina Institutional Review Board and the Malawi National Health Sciences Research Committee approved this study.

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Yohann, A., Kajombo, C., Mulima, G. et al. Inter-hospital Transfer Delays to a Tertiary Referral Center and Postoperative Outcomes in Patients with Abdominal Surgical Emergencies in Malawi. World J Surg 46, 2085–2093 (2022). https://doi.org/10.1007/s00268-022-06592-z

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  • DOI: https://doi.org/10.1007/s00268-022-06592-z

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