Patient Related And Healthcare Related Factors Associated With Delayed Presentation Among Patients Undergoing Emergency Gastrointestinal Surgery In Peshawar:A Cross Sectional Study

Abstract

Emergency gastrointestinal (GI) conditions such as acute appendicitis, intestinal obstruction, gastrointestinal perforation, strangulated hernia and other acute abdominal pathologies are important causes of emergency surgical admission and may rapidly progress to serious complications if timely treatment is not provided. The outcome of these conditions depends not only on the severity of the underlying disease but also on how quickly patients recognize symptoms, seek medical attention, reach an appropriate health-care facility and receive definitive surgical treatment. Delays occurring at any stage of this pathway can allow disease progression and increase the risk of complications, prolonged hospitalization and mortality. Evidence from emergency abdominal surgery has demonstrated that increasing time to definitive treatment is associated with poorer outcomes, particularly among patients requiring emergency laparotomy.¹,²

Delayed presentation is a multifactorial problem, particularly in low- and middle-income countries (LMICs), where socioeconomic conditions, limited health literacy, geographical barriers and deficiencies in health-care infrastructure may influence access to emergency surgical care. Patient-related factors include failure to recognize the seriousness of symptoms, assuming that symptoms will resolve spontaneously, self-medication, use of traditional or alternative treatment, fear of surgery, financial constraints and difficulties obtaining transportation. A scoping review of delays in accessing appendectomy in LMICs found that lack of awareness of symptoms, self-medication and alternative health-care practices were important contributors to delayed care, while financial barriers could affect patients throughout the care pathway.³ Similarly, a study of patients with surgical acute abdomen reported that age, educational status, family circumstances and unfamiliarity with health-care facilities were among factors associated with delayed reporting.