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Surgery far from the risk it once was

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The number of deaths resulting from surgery in Victoria is extremely low and falling each year, an audit of surgical mortality in the State has shown.

The Victorian Audit of Surgical Mortality’s (VASM) sixth annual report presents the results of reviews conducted into 3948 deaths over six years from July 1 2007 to June 31 2013. During that period, more than three million patients underwent surgical procedures in Victoria.

VASM Clinical Director and practising surgeon, Barry Beiles, said the data showed that surgical mortality was very low at 0.3 per cent, and has fallen with each successive year, despite increasing numbers of operations being performed in Victoria.

“Most surgical deaths in Victoria are elderly patients (85.6 per cent) admitted as emergencies and with other severe health problems,” Mr Beiles said.

“As we grow older we have more complex diseases and often more complex surgical procedures that could lead to complications.”

Causes of death in elderly patients were often linked to their pre-existing health status and the review process almost always assessed these deaths as not preventable. The most common causes of death reported were cardiac and respiratory failure.

“Providing feedback in these cases is essential to the audit’s overarching purpose, which is the ongoing education of surgeons and the improvement of surgical care for all patients,” Mr Beiles said.

The audit found that the majority of hospital deaths occured in the public sector, but said this was not a reflection on the level of care provided. Rather, it was the result of the less complex case-mix of patients in private hospitals.

Mr Beiles said that trends relating to clinical risk management showed overall improvements in patient surgical care, with monitoring to continue in the three high priority areas of: action to avoid deep vein thrombosis post-surgery; use of critical care facilities post-surgery; and adequate fluid balance management.

But he said that, along with other states and territories, VASM had consistently identified key risk management issues as ongoing areas for improvement. They are: delay in implementing definitive care; poor communication between health professionals, especially for coordination of patient care; operative management issues; and diagnosis-related problems.

The report recommended that surgeons focus on better documentation of clinical events; taking action on evidence of clinical deterioration; improving communication between health professionals; improving awareness of shared care requirements; and improved clinical patient care management before, during and after surgery.

The audit is funded by the Victorian Department of Health and managed by the Royal Australasian College of Surgeons.

Debra Vermeer