Surgical and anesthetic mortality at a University Hospital: A study of 200,901 patients

Abstract

BackgroundFew studies have comprehensively examined death associated with surgery and anesthesia in teaching and referral hospitals. This study evaluated the mortality in patients undergoing various surgeries under anesthesia at Jordan University Hospital. MethodsMortality data from the medical charts of patients who underwent surgery from January 1, 1990 to December 31, 2007 were reviewed to determine the cause of death following adverse anesthetic or surgical events during the course of management. The cause of death was classified into one of the following groups: surgical adverse events, anesthetic adverse events, patient disease or condition, and indeterminate cause of death. ResultsOverall, 1,290 subjects died after 241,300 procedures performed on 200,901 patients with a death rate of 0.64%. Versus survivors, the patients who died had higher ASA physical status scores and underwent more emergency surgical procedures. Death was significantly higher in males, in children under one year, and in patients above 60 years of age; 78% of deaths were due to the patient's disease or condition, and 25% were due to sepsis.The cause of death could not be determined in 5.6% of the patients who died. Surgical and anesthetic adverse events were found in 13.6% and 2.9% of deaths. The main surgical adverse events were bleeding and anastomotic leaks; respiratory and medication-related problems were the main anesthetic adverse events. The causes of death in 7% and 1.62% were considered to be preventable surgical and anesthetic adverse events, respectively. ConclusionDeath was more prevalent in patients with preoperative malignancy, cardiovascular disease, trauma, head injury, and congenital anomalies. Attention should be paid to improve surgical and anesthetic management in these patients. Adverse events were found in one-sixth of deaths. Preventable surgical and anesthetic adverse events occurred in 8.62% of the total deaths.