cwm hospital peri-operative mortality 2013 · •2 typhoid enteric perforations •2 penetrating...
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CWM Hospital Peri-operative Mortality 2013
Josese Turagava – General/ Paediatric Surgeon.
Outline:
• Fiji population/ Cent-east
• Number of procedures in CWMH
• Study methodology
• Results
• In breakdown
• comparisons
Fiji population 2010:
• Population in Fiji : -893024 (2010)
• Itaukei: - 53%
• Indian descent: - 42%
• Others: - 5%
• -statistics – Ministry of health, Fiji.
jos2raga4@yahoo.com 3
Divisional Breakdown:
• Total Population: -893024 (2010)
• Cent- East: 390974 (44%)
• Western : 361130 (40%)
• Northern : 140920 (6%)
• -Ministry of Health Statistics - 2004 & 2010.
jos2raga4@yahoo.com 4
CWM Hospital
• 442 bed hospital and one of the divisional hospitals
• Main tertiary hospital for Fiji where the specialist services are based.
2012-2013 figures:
CWMH Operation Theatre report 2013
Specialty Total Cases % of usage
General/ paed. 2230 43% -(5-paeds, 18 –diabetic limbs sepsis)
Urology 106 2%
Obs & Gynae 1943 37% -(28 –caesarian sections)
ENT 152 3%
Dental 64 1.2%
Orthopaedics 648 12%
Neurosurgery 29 0.6%
Eye 17 0.9%
Total 5189 99.9%
Hurdles in this study:
• Patis system do not have a usable surgical module
• Record keeping poor – (2/3 of folders missing)
• Methodology:
– wards and operating theatre logbooks were used to do this study to supplement missing folders
Results:
• 73 records deaths from January 1- December 31st 2013
– 1 elective case (colostomy closure/ Severe Asthma)
– 72 emergency cases
– 11 –ASA 3 and 62 ASA 4
Mortality Results: Number/ total 24 hrs 7 day 30 day Mortality
General / Paed. 22 (22/1297) 8 14 22
Sepsis 29 (29/933) 3 24 29
Urology 1 (1/106) - - 1
Obstetrics 2 (2/1470) - 1 2
ENT - - - -
Dental - - - -
Orthopaedics 1 (1/648) - - 1
Neurosurgery 12 cases (7 cases before Allan arrived)
1 10 12
Eye - - - -
Burns 4 - 2 4
Cardiac 2 1 2 2
Total 73/ 5189 13/73 53/73 73/73
Diabetes sepsis 29/73 deaths (40%):
• Diabetes rates in Fiji is alarming 20% of population
• Amputation rates: 1 amputation every 12 hours (697amputations in Fiji in 2010)
• Behaviour and attitudes - Most people come in very late and preference of traditional medicine
• All ASAs of 3& 4
Trauma
• Neurosurgery – 6 /12 related to trauma
• All the burns
• 1-Orthopaedic trauma – MVA –knee/ femur fracture with vascular compromise
• 2- chest trauma from MVA and abdominal trauma resulted in death
General Surgery:
• 2 NEC in pre-terms • 1 anaplastic thyroid Cancer with obstruction and neck
sepsis • 2 typhoid enteric perforations • 2 penetrating chest/ abdominal trauma • 8 bowel obstructions (cancer/ perforations) • 2 perforated appendix sepsis • 2 massive UGI bleed • 1 Acute mesenteric ischemia • 1 elective stoma reversal – died severe asthma • 1 esophageal dilatation - perforation
30 Day mortality
Place Year Case Mix Number Rate per 100 procedures
Reference
New Zealand
2005-2009 Elective Emergency
10226 2.1 Elective 9.8 Emerg
POMRC NZ 2011
CWM Hospital – Fiji
2013 All 5189 1.4 -current study
Mortality on day of surgery or within 24 hours
Place Year Procedure Sample Rate per 100 procedures
reference
New Zealand
2005-2009 Emergency 132,669 0.5313 POMRC 2011
New Zealand
2005- 2009 Elective 1,032,114 0.0661 POMRC
Zimbabwe 1992 All Surgery 34,553 0.258 Mckenzie 1996
CWMH – Fiji 2013 All Surgery 5189 0.25 -current study
The Future:
• New information systems for the operating theatre will have this mortality done electronically (October –November planning phase for PATIS plus)
• Ongoing data collection now for the future and medical records keeping recording data as we go.
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