title: Associations with Perioperative Mortality Rate at a Major Referral Hospital in Rwanda.
abstract: BACKGROUND
  Little is known about perioperative mortality in sub-Saharan Africa. The perioperative mortality rate (POMR) and associated factors at a major referral hospital in Rwanda were measured.
  
  
  METHODS
  The operative activity at University Teaching Hospital of Kigali was evaluated through an operative database. As a part of this larger study, patient characteristics and outcomes were measured to determine areas for improvement in patient care. Data were collected on patient demographics, surgeon, diagnosis, and operation over a 12-month period. The primary outcome was POMR. Secondary outcomes were timing and hospital location of death.
  
  
  RESULTS
  The POMR was 6 %. POMR in patients under 5 years of age was 10 %, 3 % in patients 5-14 years and 6 % in patients age >14 years. For emergency and elective operations, POMR was 9 and 2 %, respectively. POMR was associated with emergency status, congenital anomalies, repeat operations, referral outside Kigali, and female gender. Orthopedic procedures and age 5-14 years were associated with decreased odds of mortality. Forty-nine percent of deaths occurred in the post-operative recovery room and 35 % of deaths occurred within the first post-operative day.
  
  
  CONCLUSIONS
  The POMR at a large referral hospital in Rwanda is <10 % demonstrating that surgery can save lives even in resource-limited settings. Emergency operations are associated with higher mortality, which could potentially be improved with faster identification and transfer from district hospitals. Nearly half of deaths occurred in the post-operative recovery room. Multidisciplinary audits of operative mortalities could help guide improvements in surgical care.
authors.affiliation: University Teaching Hospital-Kigali, 1024 Rue de la Paix, Kigali, Rwanda. jlr283@mail.harvard.edu.|Center for Surgery and Public Health, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street, 4-020, Boston, MA, 02120, USA. jlr283@mail.harvard.edu.|, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA. jlr283@mail.harvard.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Rickard
authors.affiliation: Department of Surgery, College of Medicine and Health Sciences, University of Rwanda, P.O. BOX 4285, Kigali, Rwanda.
authors.forename: Georges
authors.initials: G
authors.lastname: Ntakiyiruta
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street, 4-020, Boston, MA, 02120, USA.|Department of Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Chu
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality; D019637:Orthopedic Procedures; D059035:Perioperative Period; D012086:Reoperation; D012189:Retrospective Studies; D012432:Rwanda; D012737:Sex Factors; D066231:Surgeons; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers; D055815:Young Adult