Surgical Mortality at a Mission Hospital in Western Uganda

Abstract

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 82.6% were done under general anaesthesia and17.4% died on table. The laparotomy death rate was 12.5%, Herniorrhaphy 0.9%, drainage of pus 1.4% and 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 20.9% and 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 the health workers’ general approach to making more information available in a meaningful way for continuous improvement of surgical services.