TY - JOUR
T1 - Associations with Perioperative Mortality Rate at a Major Referral Hospital in Rwanda
AU - Rickard, Jennifer L.
AU - Ntakiyiruta, Georges
AU - Chu, Kathryn M.
N1 - Publisher Copyright:
© 2015 Société Internationale de Chirurgie.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background: Little is known about perioperative mortality in sub-Saharan Africa. The perioperative mortality rate (POMR) and associated factors at a major referral hospital in Rwanda were measured. Methods: The operative activity at University Teaching Hospital of Kigali was evaluated through an operative database. As a part of this larger study, patient characteristics and outcomes were measured to determine areas for improvement in patient care. Data were collected on patient demographics, surgeon, diagnosis, and operation over a 12-month period. The primary outcome was POMR. Secondary outcomes were timing and hospital location of death. Results: The POMR was 6 %. POMR in patients under 5 years of age was 10 %, 3 % in patients 5-14 years and 6 % in patients age >14 years. For emergency and elective operations, POMR was 9 and 2 %, respectively. POMR was associated with emergency status, congenital anomalies, repeat operations, referral outside Kigali, and female gender. Orthopedic procedures and age 5-14 years were associated with decreased odds of mortality. Forty-nine percent of deaths occurred in the post-operative recovery room and 35 % of deaths occurred within the first post-operative day. Conclusions: The POMR at a large referral hospital in Rwanda is <10 % demonstrating that surgery can save lives even in resource-limited settings. Emergency operations are associated with higher mortality, which could potentially be improved with faster identification and transfer from district hospitals. Nearly half of deaths occurred in the post-operative recovery room. Multidisciplinary audits of operative mortalities could help guide improvements in surgical care.
AB - Background: Little is known about perioperative mortality in sub-Saharan Africa. The perioperative mortality rate (POMR) and associated factors at a major referral hospital in Rwanda were measured. Methods: The operative activity at University Teaching Hospital of Kigali was evaluated through an operative database. As a part of this larger study, patient characteristics and outcomes were measured to determine areas for improvement in patient care. Data were collected on patient demographics, surgeon, diagnosis, and operation over a 12-month period. The primary outcome was POMR. Secondary outcomes were timing and hospital location of death. Results: The POMR was 6 %. POMR in patients under 5 years of age was 10 %, 3 % in patients 5-14 years and 6 % in patients age >14 years. For emergency and elective operations, POMR was 9 and 2 %, respectively. POMR was associated with emergency status, congenital anomalies, repeat operations, referral outside Kigali, and female gender. Orthopedic procedures and age 5-14 years were associated with decreased odds of mortality. Forty-nine percent of deaths occurred in the post-operative recovery room and 35 % of deaths occurred within the first post-operative day. Conclusions: The POMR at a large referral hospital in Rwanda is <10 % demonstrating that surgery can save lives even in resource-limited settings. Emergency operations are associated with higher mortality, which could potentially be improved with faster identification and transfer from district hospitals. Nearly half of deaths occurred in the post-operative recovery room. Multidisciplinary audits of operative mortalities could help guide improvements in surgical care.
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U2 - 10.1007/s00268-015-3308-x
DO - 10.1007/s00268-015-3308-x
M3 - Article
C2 - 26546186
AN - SCOPUS:84959471205
SN - 0364-2313
VL - 40
SP - 784
EP - 790
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 4
ER -