Perioperative mortality of emergency and elective surgical patients in a low-income country: a single institution experience

Abstract

The perioperative mortality rate is an indicator of access to safe anesthesia and surgery. Studies showed higher perioperative mortality rates among low- and middle-income countries. But the specific causes and factors contributing to perioperative death have not been adequately studied in the Ethiopian context. This is a retrospective institutional study of the largest academic medical center in Ethiopia. Data of all patients who were admitted to surgical wards or intensive care and underwent surgical interventions were evaluated for perioperative mortality rate determination. All mortality cases were then evaluated in depth. Of the 3295 patients evaluated, a total of 148 patients (4.5%) died within 30 days of surgery. By the 7th postoperative day, 69.5% of the perioperative mortality had already occurred. Septic shock contributed to 54.2% of deaths. Emergency surgery patients had more than a twofold higher mortality rate than elective surgery patients (p value < 0.001) and had a 2.6-fold higher rate of dying within 7 days of surgery (p value of 0.02). Patients with ASA performance status of 3 or more had a 1.7-fold higher rate of death within 72 h of surgery (p value of 0.015). More than two thirds of patients died within 7 postoperative days. More emergency patients died than elective counterparts, and emergency cases had a higher rate of dying within 7 days of surgery. Poor ASA performance score was associated with earlier postoperative death. Further prospective multi-institutional studies are warranted to elucidate the factors that contribute to higher postoperative mortality in low-income country patients.