Perioperative Mortality Rate for Tonga from 2015-2019, TONGA experience

The Lancet Commission on Global Surgery proposed the perioperative mortality rate (POMR) as one of the six key indicators of the strength of a country’s surgical system. Despite its widespread use in high-income settings, few studies have
described procedure specific POMR across low-income and middle-income countries (LMICs). We aimed to find out the POMR for Tonga from 2015 to 2019. This was a retrospective, multi-center study of patients admitted to a hospital in
Tonga and had a surgical procedure in the operating theatre suite between the 1st of January,2015 to the 31 of December 2019. Those who had a surgical operation was followed-up whether discharge alive or dead. A total of 12879 patients was included in this study which is 84% of the total number of patients who has surgical procedure over the past five years. Tonga has an average of 3000 operations per year. The perioperative mortality rate for Tonga was a range from 0.18% to 0.49% with an average of 0.34%. Gender was also noted that male has higher POMR than female 0.39% and 0.28%. Age is a factor contributing to the POM and it was significant in the patient above 60 years of age with POMR of .47% to 3.15%
and it was significant with a p-value <.001. The surgical emergency procedure has higher POMR than elective range from .80 – 2.3% and .18-.32 % with a p-value of <.001. The neurosurgery has the highest POMR and then the cardiothoracic with a p-value <.001. In Tonga Sepsis are the most common cause of POM over the year (47%) and cardiac related disease (30%). Mortality after surgical procedure shows more than 60% happen in the first week after the operation and 25% of it happens in the first 24 hours after surgical procedure.
Perioperative Mortality in Tonga is comparable to some of the developed countries like New Zealand and Australia. It is lower than some of the LMIC that report POMR. Continuing to monitor POMR will be important to ensure safe surgery in Tonga.
The POMR in Tonga is .34% demonstrating that surgery can save lives even in resource limited settings. Emergency operations, Age, and Neurosurgery are associated with higher mortality, which could potentially be improved with faster identification and transfer from district hospitals and awareness programmes.
Multidisciplinary audits of operative mortalities could help guide improvements in surgical care.