Auditing early operative mortality in a developing country

ABSTRACT

This study examined patient deaths occurring in the critical first 24 hours after operation in order to identify those patients in whom different management decisions might have improved survival outcomes. During a 36 month period commencing January 1, 1994, information collected prospectively on all patients operated on by the general surgery, orthopaedic, neurosurgery, cardiothoracic and genitourinary services at the University Hospital of the West Indies (UHWI) was examined. Data for all patients who died within 24 hours of the operative procedure were retrieved and these patients comprised the study group. Confirmation was obtained as to the completeness of this group and the causes of death from the hospital's autopsy records. 37 patients met the study criteria and the hospital and autopsy records of all were examined. These deaths were divided into three groups high risk (patients in extremis), medium risk (seriously ill but with reasonable chance of survival) and low risk (not expected to have any serious problem during or immediately after operation). Nine patients were deemed to be at high risk, seventeen at medium risk and eleven were placed in the low risk group. In the high risk group, the majority were trauma cases in whom the findings at operation showed that survival was not in fact possible. Among the medium risk patients there were six severe injuries and a similar number had serious cardiac disease. It was in those cases assessed as being of low risk that there was most cause for concern. The identification and documentation of this group may offer a widely applicable means of assessing and comparing the quality of perioperative surgical care.(AU)