INPATIENT PERIOPERATIVE MORTALITY FOR LAUTOKA HOSPITAL FROM 2016-2018: INCIDENCE AND RISK FACTORS

Keywords: Perioperative mortality, POMR24, POMR30, risk factors, surgical procedure
Introduction: Perioperative mortality is an outcome indicator that has been identified by the lancet commission as one of the surgical outcome measures of access to safe surgery and anaesthesia. To date there has been no study which looks at perioperative mortality rate for Lautoka Hospital. The aim of this research is to determine the incidence of perioperative mortality and to determine the risk factors associated with this outcome.
Method: This was a retrospective study conducted at Lautoka Hospital from January 2016 to December 2018. Sources of data were mainly from the anaesthetic charts plus the operation notes from the patient’s folders. The patients that were included in this study were those that died in the ward within 30 days following their operation. Risk factors variables that were assessed: Age, Gender, ASA, Surgical Procedure, Surgical Specialty, ICU admission, Multiple Operations, Urgency of Operation and Anaesthetic technique. Statistical analysis was done to find out if there was an association between the risk factors (Gender, ASA, Surgical procedure, surgical specialty, ICU admission, Urgency of Operation, Multiple Operation and Anaesthetic Technique) with either POMR 24 or POMR 30. Data was entered in MS Excel Spreadsheet and testing for association was done using Chi-Square test on SPSS.
Results: Out of the 178 confirmed deaths in the ward only 88 folders were retrieved giving a low retrieval rate of 49%. Majority of the cases were males (62.5%) as compared to females (37.5%) and majority were of the Itaukei Ethnicity which make up 59.1% of the cases. The youngest patient was a 4day old baby and the oldest was an 87year old with a median age of 55 years. The peak age distribution where most of the cases fell were ≥50years of age, this is in contrast to the age group of ≥65 years which has been considered in the literature as the high risk age group for perioperative mortality. The 30 day inpatient perioperative mortality rate for Lautoka Hospital from January 2016 to December 2018 was 0.89% or 0.89 per 100 operations per year. This is comparable to the perioperative mortality rates reported from the Pacific Islands which are <1%. The 24 hour perioperative mortality was 0.10%. The perioperative mortality was mainly made up of ASA ≥3 cases (85% of cases), septic related cases that required an operation for source control. The Septic related cases put together that made up majority of the cases under General Surgery were Bedsores, Fournier’s Gangrene, Carbuncles, Buttock and Scrotal Abscess. While under Orthopedics majority were Amputations secondary to Diabetic Related Sepsis. 51patients (58%) had their initial surgery after hours which is considered a high risk time as only the on-call will be available so if an emergency happens there is less help available increasing the risk for perioperative mortality. 31 of the 88 cases required more surgical procedures while 45 of the 88 patients required ICU admission. Chi-Square test did not show any significant association between the risk factors and either POMR 24 or POMR 30.
Conclusion: Lautoka Hospitals perioperative mortality rate although it may look better it may be an underestimation of the true perioperative mortality rate. The Risk factors although it did not show any significant association with either POMR 24 or POMR 30, the trends that are seen are similar to those that have been reported in the literature.