PATTERNS OF EMERGENCY SURGERY UTILISATION AND THEIR SOCIO-DEMOGRAPHIC CORRELATES AT MMIMSR, MULLANA, AMBALA
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Keywords
Emergency surgery; utilisation patterns; socio-demographic correlates; MMIMSR Mullana; rural Haryana; 30-day mortality; descriptive study; perioperative outcomes
Abstract
Emergency surgical services form the clinical backbone of any tertiary-care teaching hospital's capacity to manage acute life-threatening conditions. At Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Ambala — a 2,000-bed referral centre serving a largely agrarian and semi-urban population across Haryana's Ambala Division — emergency surgical caseload constitutes a substantial proportion of total operative activity. Despite this, no systematic data existed characterising the patterns, volume, diagnosis spectrum, or socio-demographic determinants of emergency surgical utilisation at this institution. The April–October 2020 study period coincided partly with the COVID-19 pandemic's first and second waves in India, creating a unique opportunity to document emergency surgical patterns under conditions of healthcare disruption.
Objectives
To describe the patterns of emergency surgical utilisation at MMIMSR, Mullana, during April–October 2020; to characterise the socio-demographic profile of emergency surgical patients; and to identify independent predictors of 30-day in-hospital mortality in this cohort.
Methodology
A hospital-based descriptive cross-sectional study using retrospective record review was conducted for all emergency surgical procedures performed at MMIMSR during April–October 2020 (N=842). Data were extracted from surgical registers, anaesthesia records, and patient case files using a validated proforma. Descriptive statistics, chi-square tests, and multivariate binary logistic regression were performed using IBM SPSS v21.0.
Results
A total of 842 emergency surgical procedures were performed over the study period. Monthly volume ranged from 88 (May 2020, during COVID-19 lockdown) to 146 (August 2020). General surgery (31.8%) and orthopaedics (23.3%) contributed the largest caseloads. Acute appendicitis (19.9%), road traffic accidents (18.1%), and intestinal obstruction (11.6%) were the most frequent diagnoses. The cohort was predominantly rural (72.9%), male (57.7%), and of lower socioeconomic class (59.4% Class IV–V). Overall 30-day mortality was 4.6%. Independent predictors of mortality included ASA grade IV–V (adjusted OR 6.84), delayed presentation > 24 hours (adjusted OR 4.22), hollow viscus perforation (adjusted OR 4.86), and multiple comorbidities (adjusted OR 3.88).
Conclusion
Emergency surgical utilisation at MMIMSR, Mullana, disproportionately affects rural, economically disadvantaged, and socially marginalised populations. The 4.6% 30-day mortality is principally driven by delayed presentation, advanced ASA grade, and disease severity at arrival — all amenable to systemic intervention through community-level emergency awareness, improved pre-hospital care pathways, and structured triage protocols at MMIMSR.
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Dr. Viral Sshaill Shah
Associate Professor, Department of Anaesthesiology, M M Institute of Medical Sciences & Research, Mullana, Ambala, Haryana, India
Dr. Arunkumar R Varun
Associate Professor, Department of Community Medicine, Adesh Medical College & Hospital, Mohri, Shahbad, Haryana, India
