Peri-operative deaths in two major academic hospitals in Johannesburg, South Africa

Ph.D., Faculty of Health Sciences, University of the Witwatersrand, 2011Background to and purpose of the study An adverse outcome during the administration of an anaesthetic may result in morbidity or mortality, the latter providing us with the most fundamental measure of the safety of anaesthesia for our patients. Peri-operative deaths due to anaesthesia have not been documented in the province of Gauteng, South Africa, since 1955. The purpose of this study was to document these deaths and compare the findings with previous South African studies, as well as some studies performed overseas. Aims and objectives This study aimed to investigate and determine the prevalence of anaesthesia associated deaths, particularly those that occurred as a direct result of anaesthesia (ACD), both general and regional in two major academic hospitals in the Johannesburg area. These were the Charlotte Maxeke Johannesburg Academic Hospital and the Chris Hani Baragwanath Maternity Hospital. The objectives included examining current legislation and the interpretation thereof with recommendations, as well as the causes or possible risk factors involved in the peri-operative deaths that were studied. vii Research methods and procedures This was a retrospective longitudinal descriptive study, in the form of a clinical audit. All peri-operative deaths during the period 2000 to 2004 were studied at both sites. Numerous data were collected from each death, and descriptive and analytical statistics performed using SAS for Windows to provide frequencies for all of the variables recorded, with subsequent categorical analysis. Results The Anaesthetic Contributory Death (ACD) rate at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) was 0.4 per 10,000, which is an improvement from the pilot study that was conducted in that hospital during 1999, but it is still higher per 10,000 than the figures from the United Kingdom. The Anaesthetic Contributory Maternal Death (ACDM) rate at the Chris Hani Baragwanath Hospital was similar to the ACD rate at the CMJAH, and similar to the rate in the United Kingdom. Conclusions The ACD rate in these two hospitals is low, and may well not improve any further, as human error cannot totally be eliminated from anaesthetic practice. The South African law does not specify a time period from the start of the anaesthetic during which a peri-operative death is classified as an ACD. This is poorly understood by the medical fraternity and general public