Mortality associated with anaesthesia at Zimbabwean teaching hospitals.

OBJECTIVE: To determine and analyse peri-operative mortality with particular emphasis on avoidable factors, in the hope that this information will lead to an improvement in standards.
DESIGN: Review of all anaesthetic-associated deaths (AADs) during the year 1992. All available records were scrutinised and further information was obtained from mortality meetings and confidential discussions.
SETTING: Harare Central and Parirenyatwa hospitals, which are referral centres. PATIENTS: Out of 34,553 subjects presenting for surgical procedures, there were 89 deaths between 1 January and 31 December 1992. MAIN OUTCOME MEASURES: Incidence of AAD, avoidable mortality rate (AMR) and classification of avoidable surgical, anaesthetic and administrative factors. MAIN
RESULTS: The incidence of AAD per 1,000 anaesthetics was 2.58. (AAD was defined as death within 24 hours of anaesthesia or failure of a patient, who was previously conscious, to regain consciousness.) There were avoidable factors in 45 (51%) of the deaths. The overall AMR was 1.34 per 1,000 operations (death classified as avoidable if mismanagement contributed to mortality). The AMR (surgical), AMR (anaesthetic) and AMR (administrative) were 0.80, 0.33 and 0.21 respectively. Scoring in each category of avoidability was done proportionately, with a maximum of one point per death awarded where there were avoidable factors). The commonest avoidable factors (in order of frequency) were uncontrolled haemorrhage, poor postoperative management, poor pre-operative management and anastomotic dehiscence.
CONCLUSIONS: This audit reveals that there were avoidable factors in 51% of peri-operative deaths. It should be possible to reduce the mortality rate by developing preventive measures.