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

Annals of Surgical Oncology · 9 authors, 6 centres

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TL;DR

This study analyzed 105 in-hospital deaths after oesophago-gastric cancer surgery in Australia using a national audit. It found that nearly half (46.7%) of the deaths were potentially preventable and were associated with more complications and clinical management issues.

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The study aimed to determine causes of death, quantify potentially preventable deaths, and identify contributing clinical management issues. Forty-nine (46.7%) deaths were classified as potentially preventable. These cases had significantly higher rates of complications such as sepsis, multiorgan dysfunction, and re-operation compared to non-preventable deaths. Thematic analysis highlighted recurrent deficiencies in patient management across all perioperative phases. The findings suggest targeted quality improvement initiatives could reduce preventable mortality after these high-risk surgeries.

STUDY TYPE

cohort

SPECIALTY

surgery

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ORIGINAL PAPER

PMC10319683

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

Annals of Surgical Oncology

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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. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-023-13571-8.

CITATION EXPORT

David S. Liu, Aly Fayed, Penelope Evans et al.. Understanding Potentially Preventable Mortality Following Oesophago-Gastric Cancer Surgery: Analysis of a National Audit of Surgical Mortality. Annals of Surgical Oncology. (2023). https://doi.org/10.1245/s10434-023-13571-8

AUTHORS

9 · 6 CENTRES

David S. Liu, Aly Fayed, Penelope Evans, Tim Bright, Ahmad Aly, Cuong Duong, John Spillane, Laurence Weinberg, David I. Watson

1grid.414094.c0000 0001 0162 7225Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia and Procedural Medicine, Austin Hospital, Heidelberg, VIC Australia
2grid.1055.10000000403978434Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
3grid.1008.90000 0001 2179 088XGeneral and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne, Department of Surgery, Austin Health, Heidelberg, VIC Australia
4grid.414925.f0000 0000 9685 0624Flinders Medical Centre, Oesophago-gastric Surgery Unit, Bedford Park, SA Australia
5grid.1014.40000 0004 0367 2697Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, SA Australia
6grid.410678.c0000 0000 9374 3516Department of Anaesthesia, Austin Health, Heidelberg, VIC Australia