Emergency general surgical admissions. Prospective institutional experience in non-traumatic acute abdomen: Implications for education, training and service

OBJECTIVE: To assess the pattern of non-traumatic acute abdomen (NTAA) in emergency general surgical admissions in Saudi Arabia (SA) and highlight the implications for education, training and patient care.

METHODS: A prospective study including all emergency general surgical admissions with NTAA at King Fahd Hospital of the University, Al-Khobar, SA over a 2-year period from October 2001 to September 2003.

RESULTS: There were 3,706 general surgical admissions; 1,661 (45%) electives and 2,045 (55%) emergencies. A total of 1,096 admissions (mean age 27.6 years, 73% males) with NTAA were analyzed. Acute appendicitis was the most common diagnosis (47%), followed by non-specific abdominal pain (19%), gallstone disease (11%) and intestinal obstruction (8%). Surgical intervention was indicated in 65% of the admissions; 77% of these had appendectomy. There were 35 patients (3%) with malignancy, and 12 hospital deaths (1%). The mean length of hospital stay (LOS) was 6.6 days. The LOS increased significantly with age.

CONCLUSION: In our setting, NTAA was the most common cause for general surgical admissions, accounting for 30% and 54% of the total surgical and emergency surgical admissions respectively. Most of the patients were young and acute appendicitis was the most common diagnosis. Further National/regional multicenter studies are needed to assess the trend of emergency surgical admissions and their impact on surgical practice, overall health care costs, medical education and training in SA.