Use of the high dependency unit, increased consultant involvement and reduction in adverse events in patients who die after colorectal cancer surgery

Observations from Australia's National Surgical Mortality Audit

BACKGROUND

Australia is the only country with a national surgical mortality audit. Every Australian surgical mortality is independently and externally reviewed by another surgeon. Extensive educational feedback to surgeons and hospitals is provided through individual patient reviews, state and national symposia and reports, and the distribution of deidentified informative cases. This study reports a longitudinal analysis of the Australian surgical morality audit.

METHODS

The standardised mortality ratio (SMR) was calculated for each state and territory, nine surgical specialties and nationally. The index year used was 2016, or every 5 years for those states with earlier data. Overall data were analysed in three groups-all deaths, postoperative deaths and non-operative deaths. Overall specialty data were analysed nationally.

RESULTS

There was a consistent progressive fall, usually in excess of 20%, in the SMR in each state and territory and by specialty when compared to the index year. This was statistically significant nationally (p = 0.044). The same change was observed in earlier years in states with longer-term data.

CONCLUSION

The period of this observational study has been associated with a nationwide fall in surgical mortality. As other improvements in care will have occurred during this period, the contribution that Australia's national mortality audit made towards the lower surgical mortality cannot be stated with certainty.

Clinical application of accelerated rehabilitation surgery in elderly patients with colorectal cancer

BACKGROUND

Gastrointestinal malignant tumors are the most common malignant tumors in elderly people in China, resulting in an increasing trend of morbidity and mortality. We conducted a non-randomized controlled trial to compare the effect of enhanced recovery after surgery (ERAS) versus Routine care on clinical outcomes in elderly patients after colorectal cancer surgery.

METHODS

This is a single center, non-random, parallel-controlled clinical trial, 60 patients aged ≥65 years will be randomized for Case group ERAS and Control group (routine care).

RESULTS

This study will help to evaluate the clinical feasibility, safety and effectiveness of ERAS in elderly patients undergoing colorectal resection compared with routine care.

PROTOCOL REGISTRATION NUMBER

ChiCTR2000034984.

The Australian and New Zealand Audit of Surgical Mortality-birth, deaths, and carriage

OBJECTIVE

This article outlines the formation of the Australian and New Zealand Audit of Surgical Mortality (ANZASM) and describes its objectives, governance, functioning and challenges.

BACKGROUND

A nationwide audit of surgical mortality provides an overview of the leading causes of death in patients who require surgical care. It identifies system or process errors, trends in deficiency of care and helps develop strategies to reduce deaths in the surgical arena.

METHODS

A standardized tool is used to systematically collect data after every surgical death. Patient details are reviewed by a peer surgeon (and in certain cases a second) to identify issues with patient management and hospital processes. The treating surgeon is then offered confidential feedback and alternate views on patient management.

RESULTS

From January 2009 to December 2012, 19,096 deaths were reported to the ANZASM. Eighty-six percent of the audited deaths occurred in patients requiring an emergency admission. Significant criticism of patient care was reported in 13% of cases with 16% of clinical issues perceived to be preventable. Western Australia, which first began the audit process, has shown a 30% reduction in surgical deaths.

CONCLUSIONS

Nationwide mortality audits are a useful and worthwhile exercise. Recommendations identified in the audit reports direct educational workshops and seminars to address these issues. They allow Departments of Health to make informed decisions in their hospitals. Through this model, and the lessons learnt, we would encourage other countries planning to set up their own audits to follow a similar concept.