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Background. Improving surgical mortality rates is a global priority, as they measure the success of surgical care systems. There is no data on Botswana's overall surgical mortality rate. Therefore, this study set out to evaluate the overall mortality rate in a surgical department at Princess Marina Hospital, a tertiary hospital in Botswana. Method. This study is a single-center quantitative and retrospective study conducted in the surgical department at Princess Marina Hospital from August 2016 to December 2019. The Department of Surgery at Princess Marina Hospital keeps a prospectively updated database for quality assurance, which started in August 2016. The study received ethical approval. We included all patients older than 12 years admitted to the surgical department. Our adults surgical wards admit patients who are older than 12 years. This study collected all mortality data and determined the overall mortality rate as a percentage of surgical admissions. Results. We retrieved 4660 admissions. The mean age was 56 (standard deviation=20.1). 66% (3083/4660) were operated. Out of the 4660 admissions, 267 deaths were registered, giving an overall mortality rate of 6%. The overall postoperative mortality rate was 3.63%(112/3083), and the non-operatively managed patient mortality rate was 9.83% (155/1577). Overall, malignancies were the leading cause of death, at 49.1%(131/267), followed by trauma at 22.1% (59/267). Conclusions. The 4-year overall surgical mortality rate at Princess Marina Hospital was 6%. The mortality rate of the nonoperatively managed patients was more than twice as high as the postoperative mortality rate. Overall, malignancies were the leading cause of death, followed by trauma. [ABSTRACT FROM AUTHOR]

Background Surgical outcomes research is limited in areas of the world with the greatest unmet surgical need and likely greatest variation in outcomes. Measurement alone may improve outcomes—the so-called Hawthorne effect. The purpose of this multicenter cohort study was to identify factors that are both feasible to collect and are associated with a major adverse event following a targeted procedure in Cape Town, South Africa. Methods A collaborative of four acute care surgical units was formed to develop a data set with minimal data burden describing outcomes after an emergency exploratory laparotomy during a 3-mo period (February-April 2015). Controlling for patient, problem, provider, procedure and process predictors, multivariate models were built to identify risk factors for a major adverse event and higher resource use after surgery in our collaborative. Results The outcomes of 450 exploratory laparotomies from the four participating hospitals were audited, 319 (70.9%) were for non-trauma and 131 (29.1%) were for trauma. The major adverse event rate was 15.7% (95% CI 12.6-19.4). In the multivariate analysis, factors associated with the primary outcome included age, American Society of Anesthesia score of greater than 2, bowel resection, preoperative CT scan, and a nontherapeutic laparotomy. A major adverse event was associated with all three outcomes assessing increased resource utilization. Conclusions This study supports the comparative outcome assessment of a high-volume or high-risk procedure as a proxy for measuring the quality of care provided in a surgical collaborative. Such an exercise can identify opportunities for quality improvement. [ABSTRACT FROM AUTHOR]