Urgency refers to any circumstance that, by its occurrence or discovery, introduces or suggests a functional or vital risk if no immediate action is taken. Surgical emergencies concern all patients admitted in an emergency and for whom a surgical intervention decision may be required within 24 hours. Emergency surgery represents for the resuscitator a situation where the patient is at risk of hemodynamic instability. Hemodynamic precariousness concerns a vast nosological sector ranging from low flow syndrome to a global oxygen (O₂) transport defect (severe hypoxemia, major hypovolemia, cardiogenic shock) to O₂ distribution anomalies by alteration of microcirculatory regulation mechanisms as encountered during septic shock [1].

Patients undergoing emergency general surgery (EGS) have much higher mortality and morbidity than those undergoing elective or scheduled procedures. US outcomes, using data from the American College of Surgeons (ACS), National Surgical Quality Improvement Program (NSQIP), showed a mortality of 14% at 30 days for patients who had undergone emergency laparotomy. A comparison of hospital performance in emergency versus elective general surgery, adjusted for patient-related and operation-related risk factors, showed that emergency status was a significant predictor for morbidity, serious morbidity, and mortality [2].

Unfortunately, the worldwide human resource gap in anesthesia services often presents a barrier to accessing life-saving and life-improving surgeries [3].

Diseases whose treatment relies on a surgical procedure are among the top 15 causes of disability in the world. By conservative estimates, 11% of the global burden of disease is attributable to diseases that could be successfully treated with surgery, with low- and middle-income countries most affected. Conditions for which surgery is one of the primary therapeutic options are expected to become increasingly common in the coming years, and by 2030, a more than 45% increase in the number of cases of common diseases, such as heart disease, cancer, diabetes, and traumas following a road accident, is expected.

It is in this context that the present study aims to contribute to the understanding of the problems related to the anesthesiological management of surgical emergencies.

This is a cross-sectional descriptive and analytical study with prospective data collection from October 1, 2023, to December 31, 2023. All patients operated on for urgent indications were included. Obstetric emergencies were excluded from this work. The variables studied were:

Socio-demographic: Age; Sex.Clinics: Reasons for admission; Physical examination at the entrance; Diagnosis made.Logistics: Diagnostic delay; waiting time for surgery.Therapeutics: Surgical gestures, Anesthesia techniques, Incidents, and complications.Prognostics: Transfer service; Death.

Surgical emergencies were defined as a delay in surgical treatment of less than 3 hours. Delay in treatment was defined as a delay in surgical treatment of more than 3 hours.

A chi-square test was done to look for variables statistically related to mortality; the p-value was considered significant if <0.05.

The data collection was conducted using a previously established survey form that allowed the collection of data from anesthesia sheets and patient hospitalization records.

During the study period, 100 patients were operated on for surgical emergencies.

The average age of our patients was 31 years ± 21.4. There was a male predominance at 62%. The main reasons for admission were: abdominal pain 58%, dyspnea 11%, and public road accident 9%. They are reported in Table 1.

Table 1. Reasons for admission.

According to the ASA classification, 53% of our patients were ASA 1U, and ASA 2U accounted for 28% of the series. A prediction of red blood cell transfusion was considered in 23% of patients. The surgical management time was >3 hours in 68% of patients. Table 2 reports the causes of the delay in management. 95% of the patients were operated on by a senior surgeon. Anesthesia was performed by a doctor in specialization in 87% of cases. The main surgical procedures are reported in Table 3. The anesthetic techniques used were: general anesthesia, 52%; rachianesthesia, 37%; sedation, 9%; and local anesthesia + sedation, 2%. Thiopental and propofol were the most used hypnotics, at 23% and 22%, respectively. The main ones at induction and during anesthesia are reported in Table 4. 12% of patients were transfused during surgery. After surgery, 5% of patients were transferred to intensive care. The average duration of surgery was 1.35 hours (0.3 - 6.2 h). We recorded a post-operative mortality of 3%. There was a statistically significant link between death and: the diagnosis of pericardial effusion (p = 0.001); and the ASA score 3U (p = 0.011).

Table 2. Reasons for the delay in care.

Table 3. Surgical acts.

Table 4. Perioperative incidents and complications.

The present study describes the epidemiological, organizational, anesthetic, and prognostic characteristics of emergency-operated patients in a context with limited resources. The results highlight several major issues already reported in the international literature, while highlighting specific features of our health environment.

This study confirms the significant weight of surgical emergencies in our context and highlights the challenges related to anesthetic management in a limited-resource environment. Mortality remains closely associated with the initial clinical severity (ASA 3U) and the vital nature of certain pathologies (tamponade). Improving the organization, the technical platform, and the level of staff training remains the key to reducing morbidity and mortality.