Outcome of the Post-Operative Patients’ Admissions in the Field of Resuscitation in Mali

Introduction: In spite of the use of the less and less invasive and the more and more effective techniques and the use of fast rehabilitation conditions of the patients in surgery, the post-operative complications (POC) stay the main reasons of admission in resuscitation service. Objective: To determine the post-operative outcome of the patients admitted in resuscitation. Patient and method: It was about a retrospective and transverse survey from June 2017 to May 2018 in the service of polyvalent resuscitation of the academic hospital center of Gabriel Touré. Have been included the patients operated for surgical or obstetric gynecology—pathologies admitted in resuscitation for post-operative complications established or potential precocious or late. The used statistical test was the Chi 2 with p < 0.05 considered meaningful. The consent of the patients or parents was gotten. The survey didn’t include a potentially danger-ous act. Results: During the period, 514 patients have been admitted in resuscitation of which 140 cases of post-operatively represented 27.2% of the admissions. Under hospitalization 35.7% of patients have presented a com-plication. The middle age of patients was 37.72 ± 20.9 years. The sex ratio was 0.70. The middle the length of hospitalization with p < 0.05. Conclusion: The post-operative admissions in resuscitation are frequent including several factors of mor-bi-mortality. A better management per and postoperative of the patients operated would reduce the death rate. The profile mark is the one of a patient admitted for hemodynamic instability.


Introduction
In the period perioperative the means of the resuscitation are used put in work to manage the patients needing a heavy surgical intervention, or those exposed threatened after an intervention to acute failure multi-visceral threatening the vital prognosis. In spite of the use of the less and less invasive and the more and more effective techniques and the use of fast rehabilitation conditions of the patients in surgery, the post-operative complications (POC) stay the main reasons of admission in resuscitation service. The infection represents the second reason of post-operative morbidity and mortality. The prognosis of the post-operatives complications passes by a precocious diagnosis and a multidisciplinary approach making intervene the anesthetist, the surgeon, the radiologist and the biologist [1]. In North America: Wanzel [2] 2 in Canada and Pittman-Waller [3] in USA have found respective a post operatives complications rates of 39% and 32% in 2000. In Europe: J.-C. Renggli [4] in Switzerland and Markus P. Mr. [5] in Germany found respectively in 2003 and in 2005 respective rates of 23.3% and 29.5%. In Africa at the South of the Sahara the post-operative complications are dominated by the post operatives infections [6]. Dem TO [6] in Senegal and Mehinto [7] in Benin recorded in 2001 respective complications rates of 11.6% and 20.9% after appendectomy and intervention of Wertheim with a rate of post-operative infection respectively of 76% and 34.9%. The admission of the patients operated in resuscitation denotes the established or potential gravity of the patient's state. We don't have any data on the types of patients admitted after surgery in our country from where the interest of this survey. The objective was to determine the outcome of the patients admitted in resuscitation.

Patient and Method
It was about a retrospective and transverse survey in the service of resuscitation

Results
During The instability hemodynamic and the change of the conscience were the predominant motives of admission with respectively 42.9% and 37.2% (Table 1).
During the hospitalization the cardiovascular complications predominated with 56% ( Table 2). The delay of intervening of the complications was 3 days in 94%.  (Table 3). More the interventions were long more the preoperative events occurred with p < 0.05. The mortality was related to the types of complications with p < 0.05; the hemorrhagic complications was more suppliers with a RR of 42 (Table 4).

Discussion
The admission in resuscitation after a surgery is a very frequent possibility. The prospective character of this survey permitted to make this report in our service of polyvalent resuscitation. The weak points of our survey were the bad storage of the files driving to the loss of some information and the precariousness constituting one handicap in the realization of some complementary exams. The frequency in our survey is more important than the one recovered in the literature [4] [5] [14] [15]. This difference seems to be explained by the choice of the inclusion criteria in the different sets. The young patients were more present in our series as in other African series [15] [16], but contrary in Europeans series [17]. These differences could be explained by the life expectancy that is low in Africa compare to Europe, and to the delay in the management of the patients in Africa. The women predominate in our serie contrary to the series of Assouto [14].
In this serie it was about only one service, in our serie all specialties were concerned.  The eclampsia was the surgical indication the more recovered. This result defers the one of Assouto [14] where the peritonitis predominated. It can be explained by the fact that our survey has fine account of all post-operative admissions. The patients classified ASA1 are the more represented. Traoré [15] found that the majority of the patients was classified ASA 2 and 3. This difference would be ex- nary hypoperfusion will generate a hypoxemia conducting to the pulmonary infectious whose prognosis is very often pejorative in intensive care. Also an acute renal insufficiency can evolve toward a chronic renal insufficiency.

Conclusion
The post-operative admission is a frequent possibility. The profile of the post-operative patients of our structure is the type of a female young patient, presenting established or potential complications and neurological hemodynamic. A perioperative adequate management in a perfect organization will permit to reduce the post-operative complications.