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A 2-year audit of perioperative mortality in Malaysian hospitals
K Inbasegaran1, P Kandasami, N Sivalingam
1Department of Anaesthesia and Intensive Care, Hospital Kuala Lumpur.
Abstract:
An audit of all perioperative deaths within seven days of surgery in 14 major public hospitals is presented. This study is part of a quality assurance programme examining the surgical and anaesthetic practices in these hospitals. During the study period from July 1992 till June 1994, 211,354 surgeries were performed and 715 deaths were reported out of which 699 were available for analysis. The data was obtained by confidential enquiry using predetermined questionnaires filled by participating surgeons and anaesthetists and analysed by a group of peers. The overall crude mortality rate was 0.34% and the majority of the deaths occurred in severely ill patients in whom the clinical management was satisfactory. Polytrauma including head, intra-abdominal and skeletal trauma accounted for 253 of the deaths (36.19%). The other causes were bowel obstruction with sepsis, burns, ischaemic limbs, congenital malformations in neonates and pregnancy-related hemorrhage. 62.52% of the deaths occurred within two days of surgery and 85.87% were related to emergency procedures. The review identified some shortfalls in perioperative care and these were lack of adequate critical care facilities, lack of supervision, unnecessary surgery in the moribund and inadequate preoperative optimisation. The results of the study have been forwarded to all participating hospitals for implementation of remedial measures.
Insights
This audit of perioperative deaths in public hospitals found a 0.34% mortality rate, with most deaths in severely ill patients. Key issues identified included inadequate critical care and preoperative optimization, necessitating remedial measures.
Area of Science:
- Medical Auditing
- Surgical Quality Assurance
- Anesthesiology Research
Background:
- Perioperative mortality is a critical indicator of surgical and anesthetic care quality.
- Previous audits have highlighted areas for improvement in patient safety and outcomes.
- Understanding the causes and patterns of early postoperative death is essential for quality improvement initiatives.
Purpose of the Study:
- To audit perioperative deaths within seven days of surgery across 14 major public hospitals.
- To identify factors contributing to mortality and assess the quality of surgical and anesthetic practices.
- To provide data for implementing targeted quality assurance and patient safety improvements.
Main Methods:
- A retrospective audit of 699 perioperative deaths within seven days of 211,354 surgeries (July 1992-June 1994).
- Data collected via confidential enquiry using standardized questionnaires completed by surgeons and anesthetists.
- Analysis performed by a peer review group to ensure objectivity and identify care shortfalls.
Main Results:
- The overall crude mortality rate was 0.34%, with 62.52% of deaths occurring within 48 hours of surgery.
- Polytrauma was the leading cause of death (36.19%), followed by bowel obstruction with sepsis and other critical conditions.
- Emergency procedures accounted for 85.87% of deaths, often in severely ill patients with satisfactory clinical management.
Conclusions:
- Significant shortfalls in perioperative care were identified, including insufficient critical care facilities and preoperative optimization.
- Recommendations for remedial measures were provided to participating hospitals to enhance patient safety and outcomes.
- The audit underscores the need for continuous quality improvement in surgical and anesthetic care, particularly for high-risk patient groups.