Over a decade of changing trends in surgical mortality; audit from a tertiary care hospital.

Objective: A retrospective audit of the trend of mortality in the general surgery service at our hospital over the last decade was conducted to reflect the complexity of cases being seen.

Methods: Mortalities of 8 separate years, a decade apart, namely 1997, 1998, 1999, and 2000 as initial years (Group-I) and 2011, 2012, 2013 and 2014 as recent years (Group-II) were reviewed.

Results: Total number of admissions in the service and surgeries performed during these two periods experienced an increase of 50.7% & 64.2 % respectively. The total mortalities showed an increase with 139 (mortality rate 0.96%) seen in Group I to 285 (mortality rate 1.31%) seen in Group II a percentage increase of 105%. Comparing the operative mortality, separately, mortality rate dropped from 1.21% to 1.16% of all surgeries. Analyzing non-operative mortality showed a significant increase from six deaths in Group-I comprising 4.3% to 76 non-operative deaths in Group-II corresponding to 26.7% (p=0.000). Deaths due to Trauma increased from 12.9% to 25.3%, p=0.04, a reversed trend was seen in deaths due to GI Bleeding 11.5% to 3.2%, p=0.001. Significantly more patients in Group-II had higher ASA levels as compared to Group-I (62% vs. 46%, p<0.005).

Conclusions: This study shows an increase in total mortality rate over the years, change was mainly due to an increase in non-operative mortality. Trauma became the predominant cause of death.