Epidemiology of non-trauma surgical deaths

It is established that 70 % of morbidity and 75 % of mortality in the surgical accident and emergency (A and E) are due to trauma. However, non-trauma deaths still are an important entity requiring a specific study to highlight their pattern, and institute improvement strategies to lower death rates.

A retrospective analysis among non-trauma surgical deaths that occurred in the A and E Department of the University of Ilorin Teaching Hospital, Ilorin, Nigeria, over 24 months was done. Data collected included age, sex, interval between onset of illness and presentation, clinical features, occurrence of prior hospital visit, investigations done, cadre of surgeons that reviewed the patients and the interventions done as part of treatment before death.

4164 patients visited the A and E, 2916 (70%) were trauma, 1251 (30%) were non-trauma conditions. There were 171 deaths, 129 (75.4%) were trauma deaths while 42 (24.6%) were non-trauma deaths. Thirty (71.4%) of the 42 had complete information for analysis. Age range was 2-95 years (mean 42.7 +/- 21.8 years) comprising 18 males and 12 females. Patients with generalized peritonitis were in the majority 8 (26.7 %) comprising typhoid perforation 4, ruptured appendix 2 and perforated peptic ulcer 2. Terminal malignancies followed closely with 6 deaths (20.0%), 3 from urological causes (2 prostatic and 1 bladder cancer), acute gastrointestinal bleeding 3 (10%), intestinal obstruction 1 (3.3 %) and others. Nineteen patients (63.3%) had visited a previous hospital where they had spent <48 hrs (4 patients), 48hrs -1 week (4 patients) and >1 week (2 patients), undocumented (9 patients). Less than 40% of the patients were able to do the requested investigations (electrolytes, X-rays and ultrasound) or got the desired interventions (blood and antibiotics)

Non-trauma deaths account for a quarter of the deaths in the A and E, generalised peritonitis and advanced malignancies were the main conditions responsible and characterized by late presentation, having spent a considerable time in a previous private hospitals.