Rickard Jennifer L, Ntakiyiruta Georges, Chu Kathryn M
University Teaching Hospital-Kigali, 1024 Rue de la Paix, Kigali, Rwanda.
Center for Surgery and Public Health, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street, 4-020, Boston, MA, 02120, USA.
World J Surg. 2016 Apr;40(4):784-90. doi: 10.1007/s00268-015-3308-x.
Little is known about perioperative mortality in sub-Saharan Africa. The perioperative mortality rate (POMR) and associated factors at a major referral hospital in Rwanda were measured.
The operative activity at University Teaching Hospital of Kigali was evaluated through an operative database. As a part of this larger study, patient characteristics and outcomes were measured to determine areas for improvement in patient care. Data were collected on patient demographics, surgeon, diagnosis, and operation over a 12-month period. The primary outcome was POMR. Secondary outcomes were timing and hospital location of death.
The POMR was 6 %. POMR in patients under 5 years of age was 10 %, 3 % in patients 5-14 years and 6 % in patients age >14 years. For emergency and elective operations, POMR was 9 and 2 %, respectively. POMR was associated with emergency status, congenital anomalies, repeat operations, referral outside Kigali, and female gender. Orthopedic procedures and age 5-14 years were associated with decreased odds of mortality. Forty-nine percent of deaths occurred in the post-operative recovery room and 35 % of deaths occurred within the first post-operative day.
The POMR at a large referral hospital in Rwanda is <10 % demonstrating that surgery can save lives even in resource-limited settings. Emergency operations are associated with higher mortality, which could potentially be improved with faster identification and transfer from district hospitals. Nearly half of deaths occurred in the post-operative recovery room. Multidisciplinary audits of operative mortalities could help guide improvements in surgical care.
关于撒哈拉以南非洲地区围手术期死亡率的情况鲜为人知。我们对卢旺达一家主要转诊医院的围手术期死亡率（POMR）及相关因素进行了测量。
通过手术数据库对基加利大学教学医院的手术活动进行评估。作为这项更大规模研究的一部分，对患者特征和结局进行测量，以确定改善患者护理的领域。收集了12个月期间患者的人口统计学信息、外科医生、诊断和手术相关数据。主要结局是POMR。次要结局是死亡时间和死亡的医院地点。
POMR为6%。5岁以下患者的POMR为10%，5 - 14岁患者为3%，14岁以上患者为6%。急诊手术和择期手术的POMR分别为9%和2%。POMR与急诊状态、先天性异常、再次手术、转诊至基加利以外地区以及女性性别相关。骨科手术和5 - 14岁年龄与死亡几率降低相关。49%的死亡发生在术后恢复室，35%的死亡发生在术后第一天内。
卢旺达一家大型转诊医院的POMR<10%，这表明即使在资源有限的环境中，手术也能挽救生命。急诊手术与较高的死亡率相关，通过更快地识别和从地区医院转诊可能会有所改善。近一半的死亡发生在术后恢复室。对手术死亡率进行多学科审核有助于指导外科护理的改进。
