Abstract
BACKGROUND: Surgically avertable deaths are high in low- and middle-income countries. However, there is a paucity of evidence about the contribution of surgical conditions to mortality in Ethiopia particularly from community settings. OBJECTIVE: The aim of this study was to assess surgically avertable deaths in the Butajira Health and Demographic Surveillance Site (HDSS), Central Ethiopia. METHODS: Records of deceased persons between 2014 and 2019 of Verbal Autopsy (VA) assessments at the Butajira HDSS were used. We employed World Health Organization(WHO) VA procedures to review and assign probable causes of death using the International Classification of Diseases 10 codes and were reviewed by two surgical residents and a senior surgeon to determine if the deaths were potentially avertable with surgical intervention. The magnitude of surgically avertable conditions was estimated using descriptive analysis. Factors associated with surgically avertable causes of death were investigated using a Poisson regression model with sandwich variance estimator. FINDINGS: From this community-based dataset (n = 636), approximately one quarter of all deaths, (26.2%) were reported as definitely or probably surgically avertable. Primary causes of death that definitely or probably could be avertable by surgical interventions were neoplasms, external causes (e.g. injuries), renal disorders, gastrointestinal disorders and perinatal causes. Deaths in men were 1.62 times more likely to have been surgically avertable compared to women (adjusted Risk Ratio 1.62; 95% CI: 1.16, 2.24). CONCLUSION: Surgically avertable causes of death in the current study were considerable, comprising a higher proportion of deaths in men than women. Strengthening the health system to improve access to surgical care is expected to reduce mortality and provide evidence for Ethiopia’s Saving Lives Through Safe Surgery (SaLTS) initiative. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12893-026-03610-y.