Hospital mortality in the surgical service of University Clinics of Lubumbashi in the Democratic Republic of the Congo: retrospective study over 6 months

Abstract

Introduction: The study of mortality in a community permits to define the axes of disease prevention and readjust health policies. In a hospital department, such a study allows monitoring and revision of therapeutic measures; these are likely to deteriorate in their implementation over the years, which requires periodic criticism. The aim of our work was to record the frequency of deaths in the surgical department of the university clinic of Lubumbashi, to specify the characteristics of the deceased population as well as the main causes of death. Patients and method: This is a descriptive cross-sectional study with retrospective data collection, examining mortality in the surgical department of the university clinic of Lubumbashi over a six-month period, from January 15, 2020 to July 15, 2020. The data were collected from the hospitalization registers and files of patients in intensive care and from the operating protocol registers, grouped together on a three-fold sheet: epidemiological-clinical, therapeutic and progressive and processed in Word and Excel. We excluded from the study patients whose death was noted on admission to the emergency room. Results: The mortality rate was 18.8%, the mean age was 49.21 ± 21.87 (Extremes: 2-93 years) and the sex ratio M / F 5.14. Emergency was the most common mode of admission in 65.12% of cases (n = 28). 51.16% of death cases (n = 22) occurred postoperatively, while in 41.86% of cases (n = 18) patients had died without being operated. There were no reported comorbidities in 74.42% of the deaths (n = 32), and diabetes mellitus was the most common comorbidity in 16.28% of the cases (n = 7). 80% of the deaths were classified ASA III (n = 20). The initial cause of death was more abdominal and digestive pathologies (emergencies) in 39.53% (n = 17) of the whole series. In our study, patients who had had surgery before death accounted for 58.14% of cases, and 40% of them had been operated on at least once. The abdominal and digestive operations were more reoperated than the others with 9/10 cases, or 90% of re-intervention. The mean operating time was 6.54 ± 3.41 (Extreme: 0 and 9 days), and the mean hospital stay was 8.4 ± 14.5 (Extreme: 0 and 61 days). Conclusion: Our work has shown that the mortality rate found at 18.8% remains high given the university status of our establishment where the patients treated are often carriers of serious pathologies and where the interveners are varied. This forces us to question ourselves, not to make ourselves feel guilty but to draw the attention of general surgery nursing staff to our shortcomings, and to correct them.