Surgical Mortality at a Mission Hospital in Western Uganda

Background: Audit of Surgical mortality seeks to focus on improvement in the process of surgical care and not on individual surgical ability. Audit of surgical mortality was conducted to establish the factors associated with the surgical deaths in Virika Hospital to propose ways of improvement. Methods: The study was conducted in Virika Mission Hospital in Western Uganda; a 155 bed capacity hospital with a surgical bed capacity of 32 located in rural Uganda.Individual case file review of the fourty three surgical deaths from 1 st July 2008 to 31 st June 2009 was conducted. Additional data was retrieved from hospital admission register; operation registers; and death certificate books. Results: The operation death rate was 1.3; all were emergencies; and 82.6were done under general anaesthesia and17.4died on table. The laparotomy death rate was 12.5; Herniorrhaphy 0.9; drainage of pus 1.4and wound suture 0.4. Surgery was delayed due to lack of blood in only one case but there was no record of lack of any resource for delaying surgery. Surgical conditions were: Injuries 39.5; Intestinal perforations 30.2; Intestinal obstruction 20.9and others 9.3. The hospital had no high dependency unit and no intensive care unit. No postmortem was conducted in all cases. Conclusion: Overall the Audit identified client; provider; administrative and community-related factors that need to be addressed collectively to reduce surgical mortality in Virika hospital. Audit of surgical mortality should be part of he health workers' general approach to making more information available in a meaningful way for continuous improvement of surgical services

The Postoperative Complications Prediction in Mulago Hospital using POSSUM Scoring System

Introduction: Prediction of complications is an essential part of risk management in surgery. Knowing which patient to operate and those at high risk of developing complications contributes significantly to the quality of surgical care and cost reduction. The postoperative complications of patients who underwent Laparotomy in Mulago hospital were studied using POSSUM scoring system. The main objective of this study was to determine the postoperative complications of Laparotomy in Mulago Hospital; between September 2003 and February 2004. Methods: consecutive patients; who underwent Laparotomy in Mulago; were studied using POSSUM system for development of complications. For each patient operated; they were followed up in wards until discharge. When the postoperative complications were reported; they were reexamined by the surgeons; treated and followed up for 30 days postoperatively. Phone contacts were used for the follow up. Surgical reviews were conducted once a week in Mulago Hospital and the data obtained recorded in the data sheet for the patients. Results: Seventy-six patients were studied. The observed post operative complications were as follows: Respiratory tract infection (28.2); wound haemmorrhage (18.2); anaemia (15.5); hypotension (14.1); UTI (2.2); Anastomotic leak (1.4); Wound sepsis (9.9); wound dehiscence (4.2); Thromboembolism (1.4). The postoperative nursing care significantly determined the outcomes. Conclusion: Postoperative complications can be predicted in the modern management of surgery especially while using a scoring system

Mitral valve replacement at Tygerberg Hospital: a 5 year follow-up: mitral valve replacement

"This study provides 5-year follow-up data of isolated mitral valve replacements with mechanical prosthesis at a large South African tertiary hospital. It also assessed the significance of pre-operative parameters to predict mortality. This is a retrospective study of 187 patients that underwent isolated mitral valve replacement at Tygerberg Hospital from Jan 1998-Dec 2002. Twenty seven patient's data was incomplete and they were excluded from the study. All patients had rheumatic mitral valve disease and the valve lesions included mitral incompetence; mitral stenosis and mixed mitral valve disease. All patients had a mechanical prosthesis implanted (St Jude medical or Orbis bileaflet valves). The mean follow-up time was 5.41-years. The 30 day mortality was 5.62and the 5-year survival was 80. Pre-operative risk factors that significantly increased mortality were pulmonary hypertension and mitral stenosis. Valve-related complications were more common in this series compared to other First World populations but our results compare well with other Third World population groups. Valve thrombosis 4.32(0.8/yr); thromboembolism 8.71(1.61/yr); anticoagulant related haemorrhage 6.87(1.27/yr); prosthetic valve endocarditis 3.08(0.57/yr) and re-operation 8.12(1.5/yr). Conclusion: Mechanical valve replacement for mitral valve disease that requires valve replacement is still a good treatment option even in third world population groups. In our series; severe pulmonary hypertension; mitral stenosis and reoperation was statistically significantly more common in the ""non-survivors"" group."