Epidemiological pattern and outcomes of surgical acute abdomen in Ethiopia: A meta-analysis
Background: Acute abdomen is the sudden onset of nontraumatic abdominal pain, occurring over a maximum duration of 5 days. Globally, acute abdomen accounts for approximately 10% of emergency department presentations.
Methods: We conducted a meta-analysis to evaluate the burden and patient outcomes of nongynaecologic surgical acute abdomen in Ethiopia. We searched MEDLINE (via PubMed), African Journals Online (AJOL), and Google Scholar for articles published between 1 January 2007 and 31 December 2018. Additional articles were identified from the grey literature and via the reference lists of articles identified in the database search. Two reviewers independently screened candidate articles using the following inclusion and exclusion criteria: (1) published in English, (2) published from 1 January 2007 through 31 December 2018, (3) study conducted in Ethiopia, (4) study investigated human subjects, and (5) not a case report or systematic review. We employed fixed-effects modelling to estimate the pooled prevalence of surgical acute abdomen and acute abdomen–associated mortality among patients presenting for emergency care. Underlying causes of surgical acute abdomen were also evaluated, along with heterogeneity between the studies (via I2 statistic calculations and sensitivity analysis). This review was conducted using a protocol registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42019133645).
Results: The pooled prevalence of surgical acute abdomen was 41.3% (95% confidence interval [CI], 39.7%-42.9%). Most patients (1515 of 2053, 73.8%) were male. The main causes were acute appendicitis (42.1%; 95% CI, 40.0%-44.2%), bowel obstruction (35.9%; 95% CI, 33.8%-37.9%), and perforated peptic ulcers (4.5%; 95% CI, 3.5%-5.5%). Complications occurred in 19.8% of cases (95% CI, 18.1%-21.5%); the mortality rate was 5.1% (95% CI, 4.2%-6.0%). I2 values between 71% and 100% indicated significant heterogeneity across the studies in terms of all analyzed variables; sensitivity analysis yielded no findings contradicting the primary I2 analysis.
Conclusions: The main causes of surgical acute abdomen in Ethiopia were acute appendicitis and bowel obstruction. Further high-quality research is required to confirm these findings and provide more detailed evidence regarding surgical acute abdomen in Ethiopia.