Understanding Potentially Preventable Mortality Following Oesophago-Gastric Cancer Surgery: Analysis of a National Audit of Surgical Mortality

Liu, DS; Fayed, A; Evans, P; Bright, T; Aly, A; Duong, C; Spillane, J; Weinberg, L; Watson, DI

Author(s): Liu, DS; Fayed, A; Evans, P; Bright, T; Aly, A; Duong, C; Spillane, J; Weinberg, L; Watson, DI;
Details: Publication Year 2023-08,Volume 30,Issue #8,Page 4950-4961
Journal Title: Annals of Surgical Oncology
Publication Type: Research article
Abstract: INTRODUCTION: At a national level, understanding preventable mortality after oesophago-gastric cancer surgery can direct quality-improvement efforts. Accordingly, utilizing the Australian and New Zealand Audit of Surgical Mortality (ANZASM), we aimed to: (1) determine the causes of death following oesophago-gastric cancer resections in Australia, (2) quantify the proportion of potentially preventable deaths, and (3) identify clinical management issues contributing to preventable mortality. METHODS: All in-hospital mortalities following oesophago-gastric cancer surgery from 1 January 2010 to 31 December 2020 were analysed using ANZASM data. Potentially preventable and non-preventable cases were compared. Thematic analysis with a data-driven approach was used to classify clinical management issues. RESULTS: Overall, 636 complications and 123 clinical management issues were identified in 105 mortalities. The most common causes of death were cardio-respiratory in aetiology. Forty-nine (46.7%) deaths were potentially preventable. These cases were characterized by higher rates of sepsis (59.2% vs 33.9%, p = 0.011), multiorgan dysfunction syndrome (40.8% vs 25.0%, p = 0.042), re-operation (63.3% vs 41.1%, p = 0.031) and other complications compared with non-preventable mortality. Potentially preventable mortalities also had more clinical management issues per patient [median (IQR): 2 (1-3) vs 0 (0-1), p < 0.001), which adversely impacted preoperative (30.6% vs 7.1%, p = 0.002), intraoperative (18.4% vs 5.4%, p = 0.037) and postoperative (51.0% vs 17.9%, p < 0.001) care. Thematic analysis highlighted recurrent areas of deficiency with preoperative, intraoperative and postoperative patient management. CONCLUSIONS: Almost 50% of deaths following oesophago-gastric cancer resections were potentially preventable. These were characterized by higher complication rates and clinical management issues. We highlight recurrent themes in patient management to improve future quality of care.
Publisher: Springer Nature
Keywords: Humans; *Stomach Neoplasms/surgery; Australia/epidemiology; Gastrectomy; Quality Improvement; Survival Rate; Audit; Cancer; Gastric; Mortality; Oesophageal; Surgery
Department(s): Surgical Oncology
PubMed ID: 37157003
Publisher's Version: https://doi.org/10.1245/s10434-023-13571-8
Open Access at Publisher's Site: https://doi.org/10.1245/s10434-023-13571-8
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-10-03 06:40:00

Last Modified: 2023-10-04 12:44:04