One year audit of surgical activity in the largest tertiary center in Ethiopia

Abstract

Abstract Background Annually, more than 313 million procedures are conducted worldwide. However, only 6% are conducted in the low-income countries where a third of the world population lives. In Low- and Middle-Income Countries (LMICs) only, more than 143 million additional surgeries are needed to save lives and avoid disability. Overall global postoperative mortality is 7.7%, and half of these deaths occur in LMICs. In Ethiopia, about 250,000 procedures are being conducted annually. This is less than 5% of what is actually needed according to recommendation of 5000 procedures per 100,000 population per year. Methods This study is a retrospective review of surgical services, including surgical admissions, procedures, and outpatient visits. The study encompassed surgical activities from January 1, 2021 to December 30, 2021 and was conducted in Tikur Anbessa Specialized hospital. Data were collected from operative logbooks, clinic registrars, liaison office, ward registries and from monthly audit reports of each division. Results The majority of the admissions were elective, constituting 2589 (64.1%). The most frequent elective surgeries performed in the study year were great saphenous interposition graft (bypass) consisting of 12.4% of elective surgeries. Emergency admissions constitute 1449 (35.9%) of all admissions. The most frequent emergency procedures performed in the previous year were tracheostomy (35.7%). Mortality rate was available only from the general surgery division. Average mortality rates were was 0.07% for elective procedures and 2.1% for emergency procedures. Most common causes of mortality were septicemia and anastomotic leak. There were 508 cancellations in the one-year study period with lack of oxygen, Covid and lack of investigations being main reasons. Conclusion This study showed most of surgical procedures were done on elective basis. The most commonly performed procedures also are relatively more complex than previous report from the same country, reflecting the tertiary nature of the hospital. Overall, the outcome of both elective and emergency surgeries was favorable. However, all divisions should report morbidity and mortality, preferably with similar format. The cancellation rate is also high and needs intervention from the hospital and department leaders.