Mortality audit in general surgery unit and lessons learned at a Nigerian tertiary hospital: a single centre observational study

Introduction: mortality among surgical admissions is a global phenomenon, but the rates, pattern and factors that predict such deaths vary from region to region and even in one region, it varies among institutions. The aim was to document the pattern and factors that influence mortality in the general surgery unit of our institution. Methods: this was a seven-year retrospective, case-control study. All general surgery admissions managed at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria from January 2013 to December 2019 were included. Data were retrieved from case files of those managed during the period. Pattern and factors associated with increased mortality were analyzed and presented in tabular and descriptive forms. Results: of 4,898 general surgery admissions, 481 deaths were recorded, giving a crude mortality rate of 9.8%. Though highest number of deaths occurred in those in the 16-45 years age range, crude mortality rate was highest in elderly patients (>65 years). Generalized peritonitis was the most common cause of death, representing 38.9% of all deaths followed by cancers (22.9%), then abdominal injuries (16.8%). Of the 110 deaths from cancers, breast cancer (40, 36.4%) was the most important cause followed by colorectal cancers (29, 26.4%). Overall, 78.2% of the deaths occurred in emergency cases. In the logistic regression analysis, the following were significantly associated with mortality: advanced age, comorbidities, emergency presentation, high ASA scores (III-V) and delayed presentation. Conclusion: significant mortality occurs in our general surgery unit and is higher in older patients, and in those with generalized peritonitis, abdominal trauma and cancers.