E-Mail karger@karger.com Original Paper Dig Surg 2015;32:389–396 DOI: 10.1159/000438798 Changing Epidemiology of Intestinal Obstruction in Ghana: Signs of Increasing Surgical Capacity and an Aging Population Adam Gyedu   a, b Francis Abantanga   a, b Ishmael Kyei   b Godfred Boakye   b Barclay T. Stewart   a–c   a  Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, b  Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana; c  Department of Surgery, University of Washington, Seattle, WA, USA Efforts to reduce hernia backlog and expand the surgical workforce may have had an effect on intestinal obstruction epidemiology in Ghana. Increasing aging-related pathology and a higher risk of death in elderly patients suggest that improvement in geriatric surgical care is urgently needed. © 2015 S. Karger AG, Basel Introduction Globally, general surgical emergencies are responsible for more than 900,000 deaths and incur 25 million disabil- ity-associated life years annually [1]. This burden falls dis- proportionately on low- and middle-income countries (LMICs) that are least equipped to provide necessary care due to critical deficiencies in personnel, diagnostics and supplies [2, 3]. Recent recognition of this important pub- lic health problem has prompted initiatives to strengthen the surgical health systems in LMICs [4]. The effects of these efforts have led to some improvements in access to surgical care and availability of surgical resources [2]. As a result, the epidemiology and scope of operations per- formed at referral centers, which provide a disproportion- ately high proportion of surgery compared to other health care levels in LMICs, may be changing [1]. Anticipating Key Words Intestinal obstruction · Ghana · Global surgery · Aging · Hernia · Emergency surgery Abstract Introduction: This study aimed to describe the epidemiolo- gy and outcomes of intestinal obstruction at a tertiary hos- pital in Ghana over time. Methods: Records of all patients admitted to a tertiary hospital from 2007 to 2011 with intes- tinal obstruction were identified using ICD-9 codes. Sociode- mographic and clinical data were compared to a previously published series of intestinal obstructions from 1998 to 2003. Factors contributing to longer than expected hospital stays and death were further examined. Results: Of the 230 records reviewed, 108 patients (47%) had obstructions due to adhesions, 50 (21%) had volvulus, 22 (7%) had an ileus from perforation and 14 (6%) had intussusception. Hernia fell from the 1st to the 8th most common cause of obstruc- tion. Patients with intestinal obstruction were older in 2007– 2011 compared to those presenting between 1998 and 2003 (p < 0.001); conditions associated with older age (e.g. volvu- lus and neoplasia) were more frequently encountered (p < 0.001). Age over 50 years was strong factor of in-hospital death (adjusted OR 14.2, 95% CI 1.41–142.95). Conclusion: Received: May 12, 2015 Accepted after revision: July 16, 2015 Published online: August 25, 2015 Barclay T. Stewart, MD, MScPH Department of Surgery, University of Washington 1959 NE Pacific St., Suite BB-487, PO Box 356410 Seattle, WA 98195-6410 (USA) E-Mail stewarb  @  uw.edu © 2015 S. Karger AG, Basel 0253–4886/15/0325–0389$39.50/0 www.karger.com/dsu Downloaded by: HINARI Ghana 198.143.58.1 - 9/11/2015 5:56:46 AM