Factors affecting outcomes of patients with intestinal obstruction operatively managed at Alotau Provincial Hospital: a hospital-based cross-sectional study
Isaiah Borchem A , Ian Umo A * and Kennedy James AA
Abstract
Intestinal obstruction (IO) is the complete or partial blockage of the passage of intestinal contents. In Papua New Guinea, little is known about outcomes of IO. The aim of this study was to describe the operative outcomes of patients with IO and identify the factors associated with unfavourable outcomes at Alotau Provincial Hospital (APH).
A hospital-based cross-sectional study of patients diagnosed clinically with IO at APH was conducted from 1 January 2020 to 31 December 2022. Potential factors associated with having an unfavourable outcome were assessed using univariate logistic regression to determine the odds ratios (ORs). A P-value <0.05 was considered significant.
A total of 95 persons were admitted between 1 January 2020 and 31 December 2022 with IO requiring surgery. The median age was 34.8 years, and 65.2% (n = 62) of persons were males (65.2%). Adhesions were the most common cause of IO in this study, accounting for 27.4% (n = 26) of cases. There were significant odds of increased unfavourable outcome in persons with vomiting (OR 9.75, 95% CI 2.38–66.7, P = 0.001), abdominal distension (OR 2.30, 95% CI 1.14–8.52, P = 0.01), dehydration (OR 6.89, 95% CI 2.43–22.53, P = 0.0001), tachycardia (OR 3.80, 95% CI 1.39–11.45, P = 0.004), fever (OR 4.19, 95% CI 1.78–10.20, P = 0.0001), tachypnoea (OR 3.94, 95% CI 1.09–18.61, P = 0.01), hypotension (OR 1.85, 95% CI 1.21–2.85, P = 0.03), signs of IO on erect abdominal radiograph (OR 2.56, 95% CI 1.09–6.21, P = 0.01), leucocytosis (OR 4.19, 95% CI 1.78–10.2, P = < 0.0001), granulocytosis (OR 3.2, 95% CI 1.38–7.61, P = 0.003), and intensive care unit (ICU) admission (OR 6.3, 95% CI 1.98–24.01, P = 0.0001).
Intestinal obstruction remains a major surgical burden at APH, with adhesions being the most common cause. Clinical indicators such as vomiting, abdominal distension, dehydration, systemic inflammatory response, and ICU admission were significantly associated with unfavourable outcomes. These findings emphasise the importance of early recognition, timely referral, and surgical intervention, as well as the need to strengthen perioperative and critical care services in resource-limited settings such as Papua New Guinea.
Keywords: Alotau Provincial Hospital, bowel obstruction, intestinal obstruction, Milne Bay Province, mortality, outcomes, Papua New Guinea, risk factors.
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