Profiling the Surgical Burden of Non-Communicable Disease Complications Requiring Emergency Surgery in Urban Nigeria: A Situational Analysis

Non-communicable diseases (NCDs) including diabetes, hypertension, and cancer are generating a rapidly growing burden of surgical complications requiring emergency intervention in Nigerian urban hospitals. Profiling this burden is essential for planning urban surgical service expansion and NCD-surgical linkage programs. This dissertation conducts a comprehensive situational analysis of the surgical burden attributable to NCD complications at tertiary urban hospitals in Lagos, Kano, Enugu, and Abuja from 2019 to 2023. A mixed-methods design combined retrospective analysis of 2,400 emergency surgical admissions with prospective clinical audit of NCD-attributable surgical cases and qualitative interviews with surgeons and public health officials. NCD-attributable surgical emergencies constituted 34% of all emergency admissions. Diabetic foot complications and peripheral vascular disease were the most common NCD surgical presentations, followed by CRC perforation and obstruction, and hypertension-related intracerebral hemorrhage requiring neurosurgical decompression. Age-standardized NCD surgical admission rates were highest in Lagos (South West) and Kano (North West). Surgical mortality for NCD-attributable emergencies (18.2%) significantly exceeded non-NCD emergency surgical mortality (11.4%). Qualitative findings highlighted fragmented NCD-surgical care pathways and delayed referrals. The dissertation proposes an original NCD-surgical integration framework and recommends urban hospital NCD surgical preparedness programs, integrated care pathways, and a national NCD surgery registry. Keywords: non-communicable disease, emergency surgery, urban health, Nigeria, surgical burden