Surgical problems in children result in significant morbidity and mortality. A retrospective analysis of all surgical patients admitted to the Ethio-Swedish Children's Hospital (ESCH) over a five year period from 1984 to 1988 was made. There were a total of 2,281 surgical patients admitted, accounting for 22% of all hospital admissions (total = 10,364). The gastrointestinal and musculoskeletal systems were the most common systems involved. Acute appendicitis accounted for 13.9% (N = 318), cleft-lip and palate 8% (N = 183), and burns 6.9% (N = 157) of all surgical admissions. Accidents and trauma accounted for 25% of the surgical admissions (N = 564). Of these, the most common conditions were burns, car accidents, accidental falls, and foreign body aspirations. The over all mortality rate was 4% (N = 98). Acute appendicitis, intussusception, acute laryngotracheobronchitis (ALTB), and burns were associated with a high mortality. Of the neonatal admissions, one third died shortly after surgery, probably due to anaesthetic, fluid and electrolyte imbalance. Examination of the general pattern of surgical admissions revealed that many of the conditions were preventable, or amenable to medical therapy if detected early. Health education of the public is therefore necessary in order to reduce the morbidity and mortality of these conditions.
To test the feasibility of using a system for classification of surgical errors and of in-hospital deaths and long hospital stay as markers for errors in surgery we reviewed the hospital records of 273 patients with 285 admissions. During the one year study period there were in all 3767 patients admitted for surgical care. From these we selected the 131 who died in the department during the year, the 100 who had the longest stay (greater than 33 days) and the 91 patients were referred to the departments of internal medicine, infectious diseases or orthopedic surgery. Errors were classified as error of omission or commission, in diagnosis or in therapy. Possible or definitive errors were found in the care of 23% of the patients who died and in 10% of the ones with a long hospital stay. Only 3% of patients referred to other departments experienced errors. It is concluded, that "in-hospital death and "long hospital stay" can be used as markers to identify errors in surgery.
In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival. The aim of the present population-based cohort study was to evaluate the association between surgical delay by hour and mortality in high-risk patients undergoing emergency abdominal surgery in general.
All in-patients aged = 18 years having emergency abdominal laparotomy or laparoscopy performed within 48 h of admission between 1 January 2009 and 31 December 2010 in 13 Danish hospitals were included. Baseline and clinical data, including surgical delay and 90-day mortality were collected. The crude and adjusted association between surgical delay by hour and 90-day mortality was assessed by binary logistic regression.
A total of 2803 patients were included. Median age (interquartile range [IQR]) was 66 (51-78) years, and 515 patients (18.4%) died within 90 days of surgery. Over the first 24 h after hospital admission, each hour of surgical delay beyond hospital admission was associated with a median (IQR) decrease in 90-day survival of 2.2% (1.9-3.3%). No statistically significant association between surgical delay by hour and 90-day mortality was shown; crude and adjusted odds ratio with 95% confidence interval 1.016 (1.004-1.027) and 1.003 (0.989-1.017), respectively. Sensitivity analyses confirmed the primary finding.
In the present population-based cohort study of high-risk patients undergoing emergency abdominal surgery, no statistically significant adjusted association between mortality and surgical delay was found. Additional research in diagnosis-specific subgroups of high-risk patients undergoing emergency abdominal surgery is warranted.
An analysis has been made of 235 deaths that occurred among 1905 patients with peptic ulcer who constituted a random sample of the occurrence of ulcer disease in an area of Denmark comprising half a million inhabitants. The disease itself, according to the death certificate, was considered the primary cause of death in 10% of the cases; half of these had been operated on immediately before death. The other patients died more frequently than expected from the following causes: chronic bronchitis, pulmonary emphysema, cancer of the lung, cirrhosis of the liver, and cancer of the pancreas. Although the comorbidity with chronic bronchitis and emphysema was especially pronounced in patients with gastric ulcer, the association with liver cirrhosis and cancer of the pancreas occurred only in patients with duodenal ulcer. In women the mortality rate attributable to cardiac and vascular diseases was lower than expected. No excess coincidence of suicide was found. Berkson's fallacy is considered to be of much less importance as a possible explanation of the comorbidity found in the present study than in the majority of publications concerned with this question.
to examine whether the Danish 1905 cohort members had more active hospital treatment than the 1895 cohort members from ages 85 to 99 years and whether it results in higher in-hospital and post-operative mortality.
in the present register-based follow-up study the complete Danish birth cohorts born in 1895 (n = 12,326) and 1905 (n = 15,477) alive and residing in Denmark at the age of 85 were followed from ages 85 to 99 years with regard to hospitalisations and all-cause and cause-specific surgical procedures, as well as in-hospital and post-operative mortality.
the 1905 cohort members had more frequent hospital admissions and operations, but they had a shorter length of hospital stay than the 1895 cohort at all ages from 85 to 99 years. The increase in primary prosthetic replacements of hip joint was observed even within the 1895 cohort: no patients were operated at ages 85-89 years versus 2.2-3.6% at ages 95-99 years. Despite increased hospitalisation and operation rates, there was no increase in post-operative and in-hospital mortality rates in the 1905 cohort. These patterns were similar among men and women.
the observed patterns are compatible with more active treatment of the recent cohorts of old-aged persons and reduced age inequalities in the Danish healthcare system. No increase in post-operative mortality suggests that the selection of older patients eligible for a surgical treatment is likely to be based on the health status of old-aged persons and the safety of surgical procedures rather than chronological age.
The mortality associated with 338 934 procedures carried out in 1975 in 100 Finnish hospitals is reported. There were 626 deaths (1/541 or 0.18%). Mortality during the procedure was 1/5059 (0.02%). Twelve patients died primarily of anaesthesia during the procedures and 55 patients later (total anaesthetic mortality 1/5059, 0.02%). The frequency of cardiac arrest was 1/3808 (0.03%). Most of the 67 anaesthetic deaths were caused by inadequacy of management of fluid balance (17 patients) or respiratory insufficiency (15 patients). There were 12 deaths from cardiac complications, five each from technical errors and inadequate supervision after operation. The primary disease was responsible for approximately 72% of the reported deaths.