ABSTRACT
Background: Improving surgical mortality rates is a global priority, as they measure the success of surgical care systems. There is no data on Botswana's overall surgical mortality rate. Therefore, this study set out to evaluate the overall mortality rate in a surgical department at Princess Marina Hospital, a tertiary hospital in Botswana. Method: This study is a single-center quantitative and retrospective study conducted in the surgical department at Princess Marina Hospital from August 2016 to December 2019. The Department of Surgery at Princess Marina Hospital keeps a prospectively updated database for quality assurance, which started in August 2016. The study received ethical approval. We included all patients older than 12 years admitted to the surgical department. Our adults surgical wards admit patients who are older than 12 years. This study collected all mortality data and determined the overall mortality rate as a percentage of surgical admissions. Results: We retrieved 4660 admissions. The mean age was 56 (standard deviation=20.1). 66% (3083/4660) were operated. Out of the 4660 admissions, 267 deaths were registered, giving an overall mortality rate of 6%. The overall postoperative mortality rate was 3.63%(112/3083), and the non-operatively managed patient mortality rate was 9.83% (155/1577). Overall, malignancies were the leading cause of death, at 49.1%(131/267), followed by trauma at 22.1% (59/267). Conclusions: The 4-year overall surgical mortality rate at Princess Marina Hospital was 6%. The mortality rate of the nonoperatively managed patients was more than twice as high as the postoperative mortality rate. Overall, malignancies were the leading cause of death, followed by trauma.
ABSTRACT
BACKGROUND: The role of simulation in teaching technical skills to medical students is not yet well defined. Strategies for its use may be especially relevant where teachers, time, and resources are limited, especially in low-middle-income countries. METHODS: Sixty-seven third-year and 67 fifth-year medical students at the University of Botswana were taught surgical skills by a trained peer medical student, a medical officer with no specialty training or a staff surgeon. Pre- and post-intervention performance of two basic tasks (simple interrupted suture (SIS) and laparoscopic peg transfer (LPT)) and one complex task (laparoscopic intracorporeal suture (LIS)) were assessed. Subjective measures of self-perceived performance, preparedness for internship, and interest in surgery were also measured. RESULTS: The simulation program decreased the time to complete the two basic tasks and improved the objective score for the complex task. Performance of the basic skills improved regardless of the seniority of the instructor while performance of the advanced skill improved more when taught by a staff surgeon. All students had similar improvements in their self-reported confidence to perform the skills, preparedness to assist in an operation and preparedness for internship, regardless of the seniority of their instructor. Students taught by a staff surgeon felt better prepared to assist in laparoscopic procedures. CONCLUSION: Simulation-based teaching of defined surgical skills can be effectively conducted by peers and near-peers. The implications are widespread and may be most relevant where time and resources are limited, and where experienced teachers are scarce.
