Abstract
Objective:Surgical patient mortality is progressively being measured for providing better management and care in different healthcare systems world-wide. The aim of this study was to assess mortality within a surgical department and to evaluate components associated with surgical and non- surgical deaths.Methods:We retrospectively collected data including all admissions, both operative and non-operative, surgical procedures and reason of admission (for non-operative) and mortalities within three-year period (2015-2017) from Surgical Unit-2, JPMC Karachi. We assessed type of operations, admission, patient related factors including age, sex, co-morbid factors, reason, time and onset of presentation, operative notes, events, clinical cause and date/ time of death.Results:The total admissions of 5730 patients were observed in surgical ward-2 during the period of 1st of January 2015 and 31st of December 2017. There were a total of 291 deaths during this period (5.07% overall mortality rate). GIT related (peritonitis/ obstruction) (58.41%), biliarytract/ pancreatic causes (10.9%), road traffic accidents/ blunt trauma (7.21%), firearm injuries (1.71%) followed by GIT malignancies (4.81%) and Non-GIT malignancies (2.06%) were observed to be the main/ leading causes of death. Of the 291 deaths, males were 179 (6.70%) and females were 112 (3.66%). Male to female ratio of morality came out to be 1.6:1. The cause of death in our patients was sepsis (58.41%), cardiopulmonary arrest (13.0%), trauma/ gunshot injuries 8.93%, advanced malignancies (6.87%), pulmonary embolism (6.18%), myocardial infarction (5.49%) and post op bleeding (1.03%). Mortality due to delayed presentation of patient i.e. after five days of onset of symptoms (62.88%), Surgical decision/ exploration after 24 hours (33.67%). The lack of availability of ICU/ HDU in hospital contributed (51.01%) to the total surgical mortality.Conclusions:As per the study of three years (2015-2017) a fluctuating mortality pattern is observed. The increment of death was mainly among the unavoidable deaths such as GIT and Non GIT related sepsis, advanced malignancies, trauma and firearm injuries, pulmonary embolism myocardial infarction, a moderate role has also been played by miscellaneous group of patients. Delayed presentation of the patients after appearance of first symptom/ symptoms, delayed surgical decision/ exploration also came out to be significantly important factors in our studies elaborating the major difference in mortality rate.
Highlights
Reduction in death rate is a primary responsibility of treating doctor and timely decision of the surgeon can reduce the death rate of the surgical patients
The traditional case definition of in-hospital surgical mortality of deaths occurring within 30 days of admission for surgical care was included in study.[6]
The whole purpose of carrying out this study was to learn from our flaws in surgical management, improve the surgical care system, to introduce and imply new policies in health care systems in order to reduce the avoidable mortality rate
Summary
Reduction in death rate is a primary responsibility of treating doctor and timely decision of the surgeon can reduce the death rate of the surgical patients. Pak J Med Sci January - February 2021 Vol 37 No 1 www.pjms.org.pk 229 modify the ongoing policies and to forestall the events leading to avoidable deaths in surgical wards.[1,2,3] It helps in identifying various reasons related to pathology, burden of the disease, role of co-morbidities and complications of the operative procedure. It further helps in modifying or changing the surgical strategies in addition to provide more care where needed identifying the loop holes in surgical practice and to fill the gaps in a specific surgical care. The results obtained from this study will help to correct the causes behind avoidable deaths in terms of educating and creating awareness among the surgical professionals to improve the already set standards of quality of care about preventable deaths and to change, modify and strengthen the surgical setup and policies.[4,5]
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