Anesthesiologic Management of Surgical Emergencies at the University Hospital “LE LUXEMBOURG”

Introduction: Emergency surgery represents a major challenge in anesthesiology, particularly in countries with limited resources where diagnostic delays, lack of qualified personnel, and logistical deficiencies increase the risk of morbidity and mortality. Patients undergoing emergency surgery have a significantly higher mortality than those undergoing elective surgery, due to an often-compromised physiological state and limited pre-operative optimization. In this context, understanding the epidemiological, organizational, and anesthetic characteristics of patients is essential to improve practices. Methods: This is a descriptive and analytical cross-sectional study conducted from October 1 to December 31, 2023. All patients operated on for an urgent surgical indication, except obstetric emergencies, were included. The data collected focused on socio-demographic, clinical, logistical, therapeutic, and prognostic characteristics. A statistical analysis using the chi-square test was performed to identify factors associated with mortality, with a significance threshold set at p < 0.05. Results: 100 patients were operated on during the study period. The average age was 31 ± 21.4 years, with a male predominance (62%). Abdominal pain was the main reason for admission (58%). According to the ASA classification, 53% were ASA 1U, while 28% were ASA 2U. The operating time exceeded three hours in 68% of patients, mainly due to organizational constraints. Anesthesia was provided in 87% of cases by a doctor in specialization. The most common intraoperative incidents were hypotension (11%), hemorrhagic shock (3%), and septic shock (2%). The overall post-operative mortality was 3%. Two factors were significantly associated with death: pericardial effusion (p = 0.001) and ASA 3U status (p = 0.011). Discussion and Conclusion: The study highlights significant delays in care, a high proportion of progressive pathologies, and a massive use of doctors in training, illustrating the structural limits of the healthcare system. The low mortality observed (3%) could be explained by the frequent presence of senior surgeons and by the predominance of digestive pathologies. However, hemodynamic complications remain frequent, highlighting the need for pre-operative optimization and resuscitation capacity building. Improvement of operative organization, anesthetic training, and access to emergency care appears essential to further reduce morbidity and mortality in a context with limited resources.