This study was conducted at University Teaching Hospital of Kigali (CHUK). CHUK is a tertiary referral hospital in Rwanda located in the capital city of Kigali and has an acute care surgery (ACS) firm that treats emergency trauma and non-trauma surgical conditions (9).
From January 2013 to July 2020, we enrolled all patients who were treated at CHUK with an operative diagnosis of SBV. Patients enrolled from 2013 through July 2019 were enrolled retrospectively. Beginning August 2019 through July 2020, data were collected prospectively. We included all etiologies of SBV during the study period, including ileo-sigmoid knotting. We identified all patients with SBV from the operative database, ward and operative logbooks. The diagnosis of SBV was based on the assessment of the primary surgeon at time of operation. From August 1, 2019 – July 31, 2020, prospective participants were identified intraoperatively, enrolled into the study, and followed up through their hospital stay and at 30-day post-operatively.
For all participants we analyzed demographic characteristics, clinical history, diagnosis, operative details, postoperative course, and outcomes. Variables included age, gender, referral hospital, presence of insurance, income category (10), chief complaint, duration of symptoms, and presence of medical comorbidities. We collected data on specific comorbidities including diabetes mellitus, hypertension, alcohol consumption, gastritis, and human immunodeficiency virus status.
Clinical variables included vital signs on admission, presence of peritonitis, laboratory investigations, date and time of surgery, operating surgeon, operative procedure and characteristics, anatomical location of affected bowel (ileum, jejunum, or both), and American Society of Anesthesia (ASA) score. Leukocytosis was defined as a white blood cell count of > 11000/cu mm. Tachycardia was defined as a pulse rate of > 100/min. Tachypnea was defined as respiratory rate of > 20 cycles/min.
Postoperative variables included intensive care unit (ICU) length of stay, hospital length of stay, and complications. Specific in-hospital complications included reoperation, surgical site infection (SSI), mortality, postoperative malnutrition, and postoperative short gut syndrome. These complications were measured based on clinical assessment of the treating physician as documented in the patient file.
For patients enrolled prospectively, we contacted patients at 30 days postoperatively to assess outcomes through phone calls by trained data collectors. Specific outcomes assessed at 30 days included survival, SSI, hospital readmission, and home activities. Surgical site infection was defined as pus discharge from the wound or a wound requiring a dressing for more than 10 days. Postoperative hospital readmission was verified from the file. Resumption of home activities was defined based on whether the patient had returned to work.
The primary outcome of the study was in-hospital mortality. Secondary outcomes were ICU length of stay, overall hospital length of stay, reoperation, surgical site infection, postoperative malnutrition, and postoperative short-gut syndrome.
The data collection tool was developed and validated in a reliable way in that information were collected from the files of the patients. All collected data were entered into Research Electronic Data Capture (REDCap) which uses an open-source MySQL (Oracle Corporation, Cupertino, CA) database via a secure web interface, with data checks to ensure data quality (11). The database and web server were housed on secure servers that provide a stable, secure, well-maintained, high-capacity data storage environment. Access to study data in REDCap was restricted to the members of the study team.
To analyze data, we used Stata statistical software (version 13.0, StataCorp, College Station, TX). For our descriptive analysis, we reported frequencies and percentages for categorical variables; medians and interquartile ranges (IQR) for continuous variables.
The study was approved by University of Rwanda institutional review board and University Teaching Hospital of Kigali (CHUK) research ethics committee.