Mortality Trends at the Kenyatta National Hospital Surgical Operating Theaters: A 5-Year Retrospective Study

Nyamai Kituu (1), Susan Kerubo Omundi (1), Thomas Muinga Chokwe (2)

1Department of Anaesthesia, Kenyatta National Hospital, Nairobi, Kenya

2Department of Anaesthesia, University of Nairobi, Nairobi, Kenya

Correspondences to: Dr. Nyamai Kituu; email:

Received: 17 Jun 2021; Revised: 10 Nov 2021; Accepted: 13 Nov 2021; Available online: 13 Dec 2021


Background: Mortality studies inform hospital disease trends and predict possible poor outcome. This study aimed to establish mortality trends over the last 5 years and the associated risk factors at the Kenyatta National Hospital (KNH) surgical operating theaters and to establish the completeness of surgical safety checklist. Methods: In this analytical retrospective study, study population was 94,820 patients operated between January 2015 and December 2019 and a sample of all 145 patients who died intraoperatively. Sampling was done by census. Data were extracted from available 118 deceased patients’ records and analyzed using Statistical Package for Social Sciences version 25. Results: Theater mortality rate was 0.153%. Sex-specific mortality rate was higher in males than in females (23.7 and 7.4 per 10,000, respectively). The mortality rate slowly declined over the period. The risk of death in theater was higher in neonates and in patients older than 80 years (54.3 and 39.2 per 10,000, respectively), emergency patients, and general anesthesia (p<0.001). The risk of death in theater increased with American Society of Anesthesiologists (ASA) class and was higher in surgeries conducted off working hours (p<0.001). The surgical safety checklist was fully filled in 39.0% cases. Conclusion: Theater mortality trend was declining. Risk factors included extremes of age, sex, emergency surgery, increasing ASA class, and off working hours. Advocacy for use of a surgical safety checklist is needed.



Keywords: Theater death, Peri-operative mortality rate, Risk factors, Surgical safety checklist, Kenya

 Ann Afr Surg. 2022; 19(1): 33-40 



Conflict of interest: None

 Funding: None.


© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.


Theater mortality inadvertently occurs. Study of mortality trends informs disease trends seen at an institution, predicts possible poor outcome, and helps make informed decisions on improvement of quality of patient care.Kenyatta National Hospital (KNH) is a tertiary teaching and referral hospital in Kenya with a bed capacity of 1,800 and 18 operating theaters (1). It serves as a regional referral hospital for all specialties and a training institution for various medical colleges, handling both elective and emergency surgeries. There are 76 intensive care unit beds, of which 10 are dedicated to medical cases.The operating theaters are designed such that there is a common receiving area for all patients, individual operating rooms, and a common post-anesthetic care unit (PACU). Intra-operative mortality at KNH is recorded as death once a patient is received into the operating room for a surgical procedure and dies before discharge from PACU. Patients are discharged from PACU once they meet a modified Aldrete score of 9. Review of publications that used the same definition showed mortality rates of 0.16% over 7 years in Brazil and 0.057% between 2004 and 2006 and 0.133% between 2015 and 2016 in a Malawi hospital (3). At the time of this study, KNH aimed at maintaining it at ≤0.1% (4).Various factors have been associated with increased risk of peri-operative mortality. These include emergency surgery (3,5,6), American Society of Anesthesiologists (ASA) physical status >3 (7,8), extremes of age (2,5,9,10), type of operation (6,9,10,11), and multiple surgeries (10,11). Recently, the use of the World Health Organization’s (WHO) surgical safety checklist has been shown to reduce peri-operative morbidity and mortality (12,13).The purpose of this study was to establish the mortality trends at the KNH operating theaters over the last 5 years. Secondary objectives were to establish risk factors associated with theater mortality and completeness of surgical safety checklist. There has been no published baseline data on theater mortalities at the time of this study.




Logistical and ethical approval (P151//03/2020) was obtained from the KNH University of Nairobi Ethics and Research Committee (reference KNH-ERC/A/243), and the study was registered with the Department of Research and Programs at Kenyatta Nation