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Ann Thorac Surg. 2019 Nov 11. pii: S0003-4975(19)31683-2. doi: 10.1016/j.athoracsur.2019.09.060. [Epub ahead of print]

Mortality in Australian cardiothoracic surgery: findings from a national audit.

Author information

1
Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, South Australia. Electronic address: justin.chan@adelaide.edu.au.
2
Faculty of Health and Medical Sciences, University of Adelaide, South Australia.
3
Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia.
4
Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, South Australia; Discipline of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia.
5
Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia.

Abstract

BACKGROUND:

Independent peer review of mortality cases has potential to identify issues in cardiothoracic surgical patients. The Australian and New Zealand Audit of Surgical Mortality (ANZASM) aims to improve surgical care through peer reviewed assessment of all surgical mortality. The aim of this study is to describe common clinical management issues (CMIs) that contribute to patient mortality in a cohort of Australian cardiothoracic surgical patients. This approach may subsequently provide a basis for quality improvement.

METHODS:

Cardiothoracic mortality reports to ANZASM from February 2009 through December 2015 were reviewed. The surgeon report, as well as assessors comments were coded to identify CMIs. These were divided into perioperative stages (preoperative, intraoperative and postoperative), and at each stage a thematic analysis was performed.

RESULTS:

Of the 908 cases analysed, 1371 CMIs were identified. Postoperative issues were the most common (n=552), followed by preoperative (n=378) and intraoperative issues (n=370). Communication issues were present at all three stages (n=71). Overall, the most common theme was intraoperative technical issues (n=287). Many of these issues revolved around unintentional injury to anatomical structures during surgery and inadequate myocardial protection. Communication issues commonly related to surgical handover to ICU and lack of shared decision making. Also common were consultant surgeons being unaware of patient deterioration or significant changes in management.

CONCLUSIONS:

ANZASM provides valuable insights into issues affecting mortality in cardiothoracic patients. Potentially avoidable management issues play a large role in determining the outcome of these patients. Quality improvement initiatives targeting these areas may be valuable.

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