AFJOG

ORIGINAL RESEARCH Iatrogenic visceral injury (viz: bowel and bladder injury combined) had attributed to under 2% (n = 4) of the critical incidents. Venous thrombo-embolic phenomena accounted for less than one percent (0.8%) of the critical incidents. Among the 66 patients who died, 40 (61%) were HIV positive, and 26 (39%) were HIV negative (p = 0.09). The majority (94%; n = 62) of the deaths were among oncology patients, with only 2 (3%) and 1 (1%) urogynaecology and general gynaecology patients. The “omission of procedure” was the most prevalent type of critical incident, followed by death (Table 2). We recorded 66 deceased patients, of which 62 were oncology, and 4 were general gynaecology patients. Among the 62 oncology deaths, 40 were patients with cervical cancer, 12 had ovarian cancer, 9 had endometrial cancer, and 1 had gestational trophoblastic neoplasia. The four general gynaecology deaths were as follows: 1 patient with a ruptured ectopic pregnancy, one with sepsis post myomectomy and two patients died of complications after puerperal sepsis. The least common incidents were iatrogenic bladder injury during surgery. Table 2: Incidence and type of critical incidents (n = 235) Type of critical incident n (%) Omission of procedure 107 (45.5) Death 66 (28.1) Unplanned surgery 27 (11.5) Laparoscopy for acute salpingo oophoritis 8 (3.4) Sepsis 6 (2.6) Repeat laparotomy 5 (2.1) ICU admission 3 (1.3) Bowel injury 3 (1.3) Intra-abdominal bleeding 3 (1.3) Ectopic pregnancy 2 (0.9) Thromboembolic incident 2 (0.9) Repeat vaginal tear repair 2 (0.9) Bladder injury 1 (0.4) Reasons for the omission of procedure As shown in Table 3 below, various reasons led to a total of 107 procedures being omitted. Lack of theatre time was the most common reason for procedure omission. Other notable reasons for procedure omission were lack of blood for transfusion or no blood products. Administrative issues such as no availability of high care or intensive care unit (ICU) beds, absence of porters to transport patients to the theatre and no electricity contributed to a total of 5% of omission of procedures. All patients were screened for SARS- CoV-2 (Covid-19) prior to admission during the pandemic, and SARS-CoV-2 (Covid-19) positive results contributed to less than 5% of procedure omissions. The remainder of the procedure cancellations were due to a wide variety of reasons, all individually accounting for less than 1% of the cancelled procedures. Table 3: Reasons for omission of procedure (n = 107) Description n (%) No theatre time 50 (46.1) No blood products 9 (3.8) SARS-CoV-2 (Covid-19) positive 7 (3.0) New HIV diagnosis 6 (2.5) Change in management plan 6 (2.5) Medically unfit for surgery 6 (2.6) No HCA* bed 4 (1.7) No ICU* bed 4 (1.7) Not fasted 2 (0.9) Patient declined operation 2 (0.9) No histology results 2 (0.9) No porters available 2 (0.9) No electricity 2 (0.9) Low CD4 count 1 (0.4) Incomplete pre-operative investigations 1 (0.4) Reacted to blood transfusion 1 (0.4) No anesthetist available 1 (0.4) *HCA: High care area; ICU: Intensive Care Unit Details of unplanned surgical procedures In the category of the 27 unplanned surgical procedures, the majority (66%, n = 18) was due to an emergency hysterectomy, with 14% (n = 4) being re-look laparotomy for bowel injury and 7% (n = 2) bladder surgery. Myomectomy (n = 1) and vascular surgery (n = 1) each contributed to 4% of the unplanned surgical procedures (Data not shown in a table). Avoidable factors Table 4 shows details of the total one hundred and six (106) avoidable factors that were recorded. The most common avoidable factors were administrative factors, contributing to a total of 75 (70%) cancellations. The most (46%; n = 49) common avoidable reason in this category was inadequate African Journal of Obstetrics and Gynaecology | Volume 1 | Issue 1 | 2023 | 18