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