Survival status and predictors of mortality among emergency laparotomy patients in a selected governmental hospital in Addis Ababa, Ethiopia; retrospective cohort study (2020 and 2023)

Background: Emergency laparotomy is one of the highest-risk surgical procedures globally, associated with significant morbidity and mortality. The burden is especially severe in low-and middle-income countries, such as Ethiopia, where limited healthcare resources, delayed care, and inadequate postoperative management significantly contribute to these outcomes. Despite global efforts to reduce surgical mortality, a significant knowledge gap persists regarding the specific factors driving high mortality rates in these settings. This study is crucial for improving patient outcomes by identifying factors that contribute to high mortality rates and developing effective mitigation strategies. Objective: To assess survival status and predictors of mortality among emergency laparotomy patients in selected governmental hospital in Addis Ababa, Ethiopia. from January 1, 2020, to January 1, 2023. Methods: A retrospective cohort study was conducted in four government hospitals in Addis Ababa, Ethiopia between 2020 and 2023, focusing on emergency laparotomy patients. The study analyzed 374 patient charts using EpiData version 4.6.0.2 and STATA version 17. A Cox proportional hazards regression model was used to correlate independent variables with dependent variables. Bivariate and multiple Cox regression analyses were performed to identify predictors. Kaplan-Meier graphs were used for estimation. The hazard ratio hazard ratio and the 95 % confidence interval were calculated, with factors showing a p-value of <0.05 being strongly correlated with patient mortality. Results: A total of 374 patients were retrospectively followed from a sample of 379, as data for 5 patients were excluded due to not meeting the criteria because of incomplete information. the median follow-up time was 19 days. The overall mortality rate for patients who underwent emergency laparotomy was 10.43 %. Factors such as pre-existing disease (AHR = 5.43, 95 % CI 1.56, 18.97), preoperative sepsis (AHR = 1.2, 95 % CI 1.03, 3.47), intraoperative use of vasopressors (AHR = 8.49, 95 % CI 1.69, 42.65), and postoperative complications (AHR = 3.73, 95 % CI 1.02, 13.65) were significantly associated with mortality in these patients. Conclusions: The overall mortality rate among patients who underwent emergency laparotomy was high compared to previous studies. Pre-existing disease, preoperative sepsis, intraoperative use of vasopressors, and postoperative complications were significant factors. Therefore, preoperative optimization and the development of standard operating procedures are essential.