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

Excel spreadsheet:

• 2013 POMS CWMH.xlsx

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.