Research

Medical inpatient mortality at Groote Schuur Hospital, Cape Town, South Africa, 2002-2009

Landon Myer, Emilee Smith, Bongani M Mayosi

Abstract


Background. Despite the challenges facing healthcare in South Africa, empirical insights into the performance of healthcare services over time are scarce.

Methods. We analysed first admissions of adult medical inpatients to Groote Schuur Hospital, Cape Town, from January 2002 to July 2009. Data included age, sex, medical specialty, and date of admission and discharge. We used population group and hospital billing codes as proxy measures for socio-economic status (SES). We calculated the duration of stay in days from the date of admission to discharge, and inpatient mortality rates per 1 000 patient days. Poisson regression was used to estimate mortality rate ratios (MRR) in unadjusted analysis and after adjusting for potential confounders.

Results. There were 42 582 first admissions. Patient demographics shifted towards a lower SES. Median age decreased from 52 years in 2002 to 49 years in 2009, while patients aged 20 - 39 years increased in proportion from 26% to 31%. The unadjusted proportion of admissions which resulted in in-hospital deaths increased from 12% in 2002 to 17% in 2009. Corresponding mortality rates per 1 000 patient days were 17.0 (95% confidence interval (CI) 15.9 - 18.3) and 23.4 (95% CI 21.6 - 25.4), respectively (unadjusted MRR 1.37; 95% CI 1.23 - 1.53). Annual increases in mortality rates were highest during the first 2 days following admission (increasing from 30.1 to 50.3 deaths per 1 000), and were associated with increasing age, non-paying patient status, black population group and male sex, and were greatest in the emergency ward (adjusted MRR 1.73, comparing 2009 with 2002; 95% CI 1.49 - 2.01).

Discussion. Increasing medical inpatient mortality rates at a large South African academic hospital were most marked during the first 2 days after admission and appeared greatest among emergency medical inpatients.

Authors' affiliations

Landon Myer, Centre for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town

Emilee Smith, Centre for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town

Bongani M Mayosi, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital and University of Cape Town

Full Text

PDF (361KB) HTML

Keywords

Mortality, medical patients, in-hospital

Cite this article

South African Medical Journal 2013;103(1):28-31. DOI:10.7196/SAMJ.6285

Article History

Date submitted: 2012-09-06
Date published: 2012-11-08

Article Views

Abstract views: 2451
Full text views: 3306

Comments on this article

*Read our policy for posting comments here