Mortality trends at the Kenyatta National Hospital surgical operating theaters: a 5-year retrospective study

Abstract

Background: Mortality studies inform hospital disease trends and predict possible poor outcome. This study aimed to establish mortality trends over the last 5 years and the associated risk factors at the Kenyatta National Hospital (KNH) surgical operating theaters and to establish the completeness of surgical safety checklist. Methods: In this analytical retrospective study, study population was 94,820 patients operated between January 2015 and December 2019 and a sample of all 145 patients who died intraoperatively. Sampling was done by census. Data were extracted from available 118 deceased patients’ records and analyzed using Statistical Package for Social Sciences version 25. Results: Theater mortality rate was 0.153%. Sex-specific mortality rate was higher in males than in females (23.7 and 7.4 per 10,000, respectively). The mortality rate slowly declined over the period. The risk of death in theater was higher in neonates and in patients older than 80 years (54.3 and 39.2 per 10,000, respectively), emergency patients, and general anesthesia (p<0.001). The risk of death in theater increased with American Society of Anesthesiologists (ASA) class and was higher in surgeries conducted off working hours (p<0.001). The surgical safety checklist was fully filled in 39.0% cases. Conclusion: Theater mortality trend was declining. Risk factors included extremes of age, sex, emergency surgery, increasing ASA class, and off working hours. Advocacy for use of a surgical safety checklist is needed.