Kumar Dileep, Bukhari Hina, Qureshi Shamim
Dr. Dileep Kumar, Associate Professor, Department of General Surgery, Ward-2, Jinnah Postgraduate Medical Center, Karachi, Pakistan.
Dr. Hina Bukhari, Senior Registrar, Department of General Surgery, Ward-2, Jinnah Postgraduate Medical Center, Karachi, Pakistan.
Pak J Med Sci. 2021 Jan-Feb;37(1):229-233. doi: 10.12669/pjms.37.1.2040.
Surgical patient mortality is progressively being measured for providing better management and care in different healthcare systems world-wide. The aim of this study was to assess mortality within a surgical department and to evaluate components associated with surgical and non- surgical deaths.
We retrospectively collected data including all admissions, both operative and non-operative, surgical procedures and reason of admission (for non-operative) and mortalities within three-year period (2015-2017) from Surgical Unit-2, JPMC Karachi. We assessed type of operations, admission, patient related factors including age, sex, co-morbid factors, reason, time and onset of presentation, operative notes, events, clinical cause and date/ time of death.
The total admissions of 5730 patients were observed in surgical ward-2 during the period of 1 of January 2015 and 31 of December 2017. There were a total of 291 deaths during this period (5.07% overall mortality rate). GIT related (peritonitis/ obstruction) (58.41%), biliarytract/ pancreatic causes (10.9%), road traffic accidents/ blunt trauma (7.21%), firearm injuries (1.71%) followed by GIT malignancies (4.81%) and Non-GIT malignancies (2.06%) were observed to be the main/ leading causes of death. Of the 291 deaths, males were 179 (6.70%) and females were 112 (3.66%). Male to female ratio of morality came out to be 1.6:1. The cause of death in our patients was sepsis (58.41%), cardiopulmonary arrest (13.0%), trauma/ gunshot injuries 8.93%, advanced malignancies (6.87%), pulmonary embolism (6.18%), myocardial infarction (5.49%) and post op bleeding (1.03%). Mortality due to delayed presentation of patient i.e. after five days of onset of symptoms (62.88%), Surgical decision/ exploration after 24 hours (33.67%). The lack of availability of ICU/ HDU in hospital contributed (51.01%) to the total surgical mortality.
As per the study of three years (2015-2017) a fluctuating mortality pattern is observed. The increment of death was mainly among the unavoidable deaths such as GIT and Non GIT related sepsis, advanced malignancies, trauma and firearm injuries, pulmonary embolism myocardial infarction, a moderate role has also been played by miscellaneous group of patients. Delayed presentation of the patients after appearance of first symptom/ symptoms, delayed surgical decision/ exploration also came out to be significantly important factors in our studies elaborating the major difference in mortality rate.
在全球不同的医疗体系中，手术患者死亡率正逐渐被用于衡量以提供更好的管理和护理。本研究的目的是评估外科科室的死亡率，并评估与手术死亡和非手术死亡相关的因素。
我们回顾性收集了2015年至2017年三年期间卡拉奇真纳医学院外科二病房的所有入院病例数据，包括手术和非手术病例、手术操作、入院原因（非手术病例）以及死亡情况。我们评估了手术类型、入院情况、患者相关因素，包括年龄、性别、合并症因素、原因、就诊时间和发病时间、手术记录、事件、临床病因以及死亡日期/时间。
在2015年1月1日至2017年12月31日期间，外科二病房共观察到5730例入院病例。在此期间共有291例死亡（总死亡率为5.07%）。观察到胃肠道相关（腹膜炎/梗阻）（58.41%）、胆道/胰腺疾病（10.9%）、道路交通事故/钝性创伤（7.21%）、火器伤（1.71%），其次是胃肠道恶性肿瘤（4.81%）和非胃肠道恶性肿瘤（2.06%）是主要/首要死亡原因。在291例死亡病例中，男性179例（6.70%），女性112例（3.66%）。男女死亡率之比为1.6:1。我们患者的死亡原因是脓毒症（58.41%）、心肺骤停（13.0%）、创伤/枪伤8.93%、晚期恶性肿瘤（6.87%）、肺栓塞（6.18%）、心肌梗死（5.49%）和术后出血（1.03%）。患者症状出现后延迟就诊即症状出现五天后（62.88%）、24小时后进行手术决策/探查（33.67%）导致死亡。医院重症监护病房/高依赖病房的缺乏导致了51.01%的外科总死亡率。
根据对2015 - 2017年三年的研究，观察到死亡率呈波动模式。死亡人数的增加主要发生在不可避免的死亡病例中，如胃肠道和非胃肠道相关脓毒症、晚期恶性肿瘤、创伤和火器伤、肺栓塞、心肌梗死，杂类患者群体也起到了一定作用。患者在出现首发症状后延迟就诊、延迟手术决策/探查在我们的研究中也是导致死亡率存在显著差异的重要因素。
