CHAPTER ONE
INTRODUCTION
1.1 Background of Study
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas (for example, a perforated ear drum) (Fingar, Stocks, Weiss, and Steiner, 2014). Surgical care is an integral part of health care throughout the world with an estimated 234 million operations performed annually (Weiser, Regenbogen, and Thompson, 2013). Approximately 4,000 surgical procedures per 100,000 populations in many countries and up to 11,000 procedures per 100,000 populations are carried out in a much populated countries like Indian, china and United State annually. Although surgical care can improve the quality of life and prevent loss of life or limb, it is also associated with considerable risk of complications and death (Weiser, Regenbogen, and Thompson, 2013).
Mortality may result directly from the disease process necessitating surgical care, from a complication of the surgical procedure and anaesthesia or from other co-morbidities. In developing countries, late presentation, delay in diagnosis and treatment as well as limited health facilities and poor infrastructure may contribute significantly to mortality during surgical care. A study of the pattern of mortality in surgical care involves a systematic, critical analysis of the quality of surgical care and the outcome of the treatment. It can identify areas of surgical care that require improvement or modification (Ndubuisi, Onyemaechi, Popoola, Alex, Itodo and Kehinde, 2015).
In-hospital, surgical mortality is traditionally defined as death occurring within 30 days of admission for surgical care (Goldacre and Mackintosh, 2016). This definition, however, does not distinguish deaths that are not related to surgical care that is occurring during this period and mortality from surgical care occurring after 30 days which are potential sources of overestimation and underestimation of surgical death rates, respectively (Ndubuisi, Onyemaechi, Popoola, Alex, Itodo and Kehinde, 2015).
There are many studies from developed countries on various aspects of surgical mortality especially disease-specific and procedure-specific mortality rates (Dimick, Welch and Birkmeyer, 2015). However, there is paucity of reports on this subject from developing countries (Lloyd, Ahmad and Taylor, 2015).
Death rates from surgical care tend to be lower in the developed countries. McDonald, Royle, Taylor and Karran, (2014) reported a mortality rate of 2.3 percent, while Glass and Thomas (2012) reported 3.1 percent in their study. Conversely, Chukuezi and Nwosu (2010) in Owerri and Ihegihu, Chianakwana, Ugezu, and Anyanwu, 2015) in Nnewi (both in Eastern Nigeria) reported mortality rates of 9.14 and 8.3 percent, respectively. Ayoade, Thanni and Shonoiki-Oladipupo, (2013) reported a crude mortality rate of 5.09 percent in Shagamu, Southwest Nigeria. Biluts, Bekele, and Kottiso, (2012) in Addis Ababa, Ethiopia, reported a mortality rate of 7.0 percent.
The pattern of mortality from surgical care varies in many parts of the world. While disseminated cancer is a common cause of death in developed countries, trauma-related deaths are more common in developing countries (Chukuezi and Nwosu, 2010; Ayoade, Thanni and Shonoiki-Oladipupo, 2013; McDonald, Royle, Taylor and Karran, 2016).
1.2 Statement of Problem
Studies from various parts of the world on surgical mortality deal with surgical audit from different perspectives. The pattern of mortality from surgical care varies in many parts of the world. While disseminated cancer is a common cause of death in developed countries, trauma-related deaths are more common in developing countries (O’Leary, Cosford and Hardwick, 1997; McDonald, Royle, Taylor and Karran, 2014).
Irrua Specialist Teaching Hospital like any other hospital has a record of incidence of surgical mortality. However, it has been observed that the causes of death as a result surgical operation in Irrua Specialist Teaching Hospital are not always well documented.
Analysis of mortality and causes of death is an important step in identifying risk factors for death following trauma and disease. This is also useful in anticipating complications. There are many reports from different parts of the world addressing different aspects of medical and surgical mortalities. There are few reports from our country (Ndubuisi, Onyemaechi, Popoola, Alex, Itodo and Kehinde, 2015).
1.2.1 Justification of Study
Surgery is performed in every community: wealthy and poor, rural and urban. Although surgical care can prevent loss of life or limb, it is also associated with a considerable risk of complications and death (Hayes, Weiser, Beny, Lipsitz, Breizat, and Delinger, 2013). Surgical care is an integral part of healthcare throughout the world, with an estimated 234 million operations performed annually (Weiser, Regenbogen, and Thompson, 2013). (Weiser, Regenbogen, and Thompson, 2013) estimated the global volume of surgery to be 234.2 million procedures a year. According to Pearse, Harrison, James, Watson, Hinds, Rhodes, Grounds and Bennett, (2013), high-risk surgical procedures represent around 12.5 percent of this total.
Mortality is an inevitable complication of surgery. Among the sick, mortality could be due to medical or surgical reasons; medical or surgical errors; delay in treatment and error in judgment; limited hospital resources and poor infrastructures on the ground. Audit of pattern of mortality entails a systematic, critical analysis of the quality of care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patient (Anelechi, Chukuezi and Jones, 2015).
Considering this information there is need to determine the prevalence and causes of mortality among surgical patients in Irrua Specialist Teaching Hospital with a view to updating the information on previous mortality among surgical patients.
1.3 Research Questions
This study will provide answers to the following research questions.
- What are the various causes of mortality among surgical patients in Irrua Specialist Teaching Hospital from January 2012 to December 2016?
- What is the prevalence of mortality among surgical patients from January 2012 to December 2016?
1.4 Objective of the Study
The objective of the study is to determine the prevalence and causes of mortality among surgical patients in Irrua Specialist Teaching Hospital, Edo State. From January 2012 to December 2016.
1.4.1 Specific Objectives of the Study
The specific objectives of the study includes;
- To determine the causes of mortality among surgical patients in Irrua Specialist Teaching Hospital, Irrua within January 2012 to December 2016.
- To determine the prevalence of mortality among surgical patients in Irrua Specialist Teaching Hospital. From January 2012 to December 2016.
1.5 Significance of Study
This study is significant because it shall provide information on the prevalence and causes of mortality among surgical patients, it will aid in the documentation of incidence and causes of surgical mortalities in Irrua Specialist teaching hospital, it will be act as an eye opener to the general public as well as the government as to know the possible way to enlightened the populace and to improve on the management and proper operation procedure in cause of surgery processes. This study will add to the already existing information on the incidence and causes of the death among surgical patients.
1.6 Scope of Study
This research work was carried out in the surgical ward in Irrua Specialist teaching hospital, Irrua, the administrative headquarters of Esan Central Local Government Area of Edo-state, Nigeria. Irrua shares boundaries with Uromi, Ewu, Ekpoma and Ugbegun. Irrua has a population of 89,628 and 127,718 at the 1991 and 2006 population census respectively, majority of which are health workers, civil servants, traders, businessmen/women, transporters, farmers and teachers by occupation.
1.7 Research Hypothesis
These are no significant differences on the prevalence and causes of mortality among surgical patients in the hospital.
1.8 Operational Definition of Terms
This part of the research work deals with operational definition of common terms applied to this study.
Mortality: the state of being subject to death.
Surgery: The treatment of injuries or disorders of the body by incision or manipulation, especially with instruments.
Incidence: the occurrence, or frequency of a disease, crime, or other undesirable thing.
Cause: make (something, especially something bad) happen.
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