Emergency Laparotomy Outcomes among Patients in Lusaka, Zambia: A Prospective, Observational Study on Postoperative Mortality

Introduction: Postoperative mortality in sub-Saharan Africa is three times that of high-income countries, yet procedure specific outcome data from the region remain scarce. No prospective study has reported emergency laparotomy outcomes in Zambia. This study evaluates 30-day mortality, complications, and risk factors for death after emergency laparotomy at Zambia’s largest referral hospital.

Methods: Prospective observational study of consecutive adults undergoing emergency laparotomy at the University Teaching Hospital in Lusaka, Zambia (April 2024-April 2025). The primary outcome was all-cause 30-day mortality. Multivariable logistic regression identified independent predictors of death.

Results: Of the 240 patients, 28 died (12%). Sepsis was the leading cause of death (47%) and 82% of deaths occurred without an ICU admission. Patients who died were older. (45 vs 34 years, p=0.006), more often HIV positive (47% vs 21%, p=0.02), and had more comorbidities (39% vs 16%, p=0.002). More than half visited at least one facility before reaching the referral hospital. Increasing age and longer time from symptom onset to surgery were independently associated with mortality (p≤0.04).

Conclusion: Emergency laparotomy in Lusaka carries a 12% mortality, driven by delayed access to definitive surgery through serial referral. These data provide a facility level outcome baseline for Zambia’s revised National Surgical, Obstetric and Anaesthesia Plan and support investment in district-level surgical capacity to reduce preventable delays.