title: Avoidable perioperative mortality at the University Teaching Hospital, Lusaka, Zambia: a retrospective cohort study.
abstract: OBJECTIVE
  Perioperative mortality has fallen in both high- and low-income countries over the last 50 years. An evaluation of avoidable perioperative mortality can provide valuable lessons to improve care; however, there is relatively little recent data from the Least Developed Countries in the world. We aimed to compare recent avoidable perioperative mortality in Lusaka, Zambia, with historical data from 1987.
  
  
  METHODS
  We conducted a retrospective cohort study by identifying perioperative deaths within days of surgery and comparing the operating room and mortuary registers for the 2012 calendar year. Multiple independent raters from anesthesiology and surgery/obstetrics gynecology reviewed case notes, when available, to identify avoidable causes of death.
  
  
  RESULTS
  Of the 18,010 surgical patients in 2012, 114 were identified as having died perioperatively within six days of surgery. Fifty-nine files were available for further analysis (52% of identified perioperative deaths). Eighteen (30%) of these cases were assessed as avoidable, 19 cases (32%) probably avoidable, 14 cases (24%) unavoidable, and eight cases (14%) unclear. Thirty-one (53%) cases had surgical factors contributing to death, 19 (32%) cases had anesthesia factors, and 18 (30%) cases had systems factors. Most of the avoidable deaths were attributed to multiple factors. Key factors leading to the avoidable deaths were delays in surgery, lack of the availability of blood, and poor postoperative care.
  
  
  CONCLUSIONS
  Most deaths were avoidable, suggesting that patient outcomes in low-resource settings can be improved within current resources. The multifactorial nature of avoidability implies that an interprofessional approach is required to improve the quality of care.
authors.affiliation: Department of Anaesthesia, Guys and St Thomas' Hospital, London, UK.
authors.forename: Edwardina Mary Mae Alexandra
authors.initials: EM
authors.lastname: Lillie
authors.affiliation: Department of Anaesthesia, Great Ormond Street Hospital, London, UK.
authors.forename: Christopher John
authors.initials: CJ
authors.lastname: Holmes
authors.affiliation: Department of Anaesthesia, Great Ormond Street Hospital, London, UK.
authors.forename: Elizabeth Anne
authors.initials: EA
authors.lastname: O'Donohoe
authors.affiliation: Department of Anaesthesia, Royal Gwent Hospital, Newport, UK.
authors.forename: Lowri
authors.initials: L
authors.lastname: Bowen
authors.affiliation: Department of Surgery, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Chadwick L T
authors.initials: CL
authors.lastname: Ngwisha
authors.affiliation: Department of Obstetrics and Gynaecology, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Ahmed
authors.affiliation: Department of Anaesthesia, University Teaching Hospital, Lusaka, Zambia.
authors.forename: David Michael
authors.initials: DM
authors.lastname: Snell
authors.affiliation: Postgraduate Medical Institute, Anglia Ruskin University, Essex, UK.
authors.forename: John Alexander
authors.initials: JA
authors.lastname: Kinnear
authors.affiliation: Department of Anesthesiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. dbould@cheo.on.ca.
authors.forename: M Dylan
authors.initials: MD
authors.lastname: Bould
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality*; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology