Death on the operating table: A 10-year retrospective, observational descriptive case series study at Victoria Mxenge tertiary referral hospital in KwaZulu-Natal.

Viven Govender; Diran  Pillay; Larissa  Cronje

doi:10.51168/sjhrafrica.v6i9.1907

Authors

Viven Govender Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, KwaZulu-Natal, South Africa.
Diran Pillay Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, KwaZulu-Natal, South Africa.
Larissa Cronje Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa.

DOI:

https://doi.org/10.51168/sjhrafrica.v6i9.1907

Keywords:

ASOS (African Surgical Outcomes Study), Shock Index, Mortality, Risk Calculator

Abstract

Background

Death on the operating table is a rare occurrence and remains under-researched in South Africa. Multiple factors may contribute to this outcome. This study aimed to identify whether the Shock Index (SI) and ASOS (African Surgical Outcomes Study) risk calculator correlates with intraoperative mortality and explored additional contributing factors.

Methods

A ten-year retrospective case series (2013-2022) was conducted at Victoria Mxenge Hospital. This study included adult patients (Age>18years) who died on the operating table after anaesthetic induction for non-obstetric cases. Of 66920 theatre cases, 57 met our inclusion criteria. Descriptive statistics, including means, interquartile ranges (IQR), and percentages, were used for analysis.

Result

SI data were available for 35 patients; 63% had an SI >1, and 91% of these cases were emergencies. Among patients with ASA 5 status (n=18), 16 (89%) had an SI >1. Of those with ASA 4 (n=11), 6 (55%) also had elevated Shock Indices.
Emergency surgery accounted for 95% of all cases. Among patients with ASOS scores of 10–18 (n=8), 63% were emergencies; all patients with ASOS scores ≥19 (n=49) were emergencies. ASA 4 and 5 accounted for 53% and 37% of all deaths, respectively. Of the six cases classified as ASA 2 or 3, five had ASOS scores of 10–18, and one had a score ≥19.
Hypovolemic shock was the most likely cause of death in 65% of cases, followed by septic shock (19%) and obstructive shock due to pulmonary embolism (9%).

Conclusion

The SI and ASOS risk calculators are useful tools; identifying high-risk surgical patients and guiding escalation of care. Elevated scores correlate with poorer outcomes.

Recommendation

The use of the Shock Index and ASOS risk calculator may facilitate earlier intervention and resource mobilisation, potentially reducing intraoperative mortality.

Author Biographies

Viven Govender, Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, KwaZulu-Natal, South Africa.

ORCID ID: 0009-0000-8437-8323

Completed medical degree at Walter Sisulu University (WSU) in 2009

Post Anaesthetic Fellowship exams in 2021 with CMSA (College of Medicine of South Africa). Currently employed in the Department of Anaesthesia at VMH - Victoria Mxenge Hospital (Formerly King Edward Academic Hospital).

Diran Pillay, Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, KwaZulu-Natal, South Africa.

ORCID ID: 0009-0002-2198-4566

Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, KwaZulu-Natal, South Africa.

Specialist Anaesthesiologist in the Critical Care Unit at VMH.

Larissa Cronje, Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa.

ORCID ID: 0000-0015508-7471

Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management. University of KwaZulu-Natal, Congella, KwaZulu-Natal, South Africa.

Specialist Anaesthesiologist.

Currently, the Head of Department of Anaesthesiology at Inkosi Albert Luthuli Central Hospital with a special interest in Paediatric Anaesthesia. Former Head Clinical Unit at VMH.

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