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Observations from Australia’s National Surgical Mortality Audit

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Abstract

Background

Australia is the only country with a national surgical mortality audit. Every Australian surgical mortality is independently and externally reviewed by another surgeon. Extensive educational feedback to surgeons and hospitals is provided through individual patient reviews, state and national symposia and reports, and the distribution of deidentified informative cases. This study reports a longitudinal analysis of the Australian surgical morality audit.

Methods

The standardised mortality ratio (SMR) was calculated for each state and territory, nine surgical specialties and nationally. The index year used was 2016, or every 5 years for those states with earlier data. Overall data were analysed in three groups—all deaths, postoperative deaths and non-operative deaths. Overall specialty data were analysed nationally.

Results

There was a consistent progressive fall, usually in excess of 20%, in the SMR in each state and territory and by specialty when compared to the index year. This was statistically significant nationally (p = 0.044). The same change was observed in earlier years in states with longer-term data.

Conclusion

The period of this observational study has been associated with a nationwide fall in surgical mortality. As other improvements in care will have occurred during this period, the contribution that Australia’s national mortality audit made towards the lower surgical mortality cannot be stated with certainty.

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Data availability

The ANZASM data will not be available to third parties.

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Acknowledgements

The Australian and New Zealand Audit of Surgical Mortality is organised by individual Australia state and territories. Each has a Clinical Director and office with supporting staff. It is co-ordinated from the Royal Australian College of Surgeons (RACS) Adelaide office. The support and help of many individuals are acknowledged with thanks.

Funding

The Australian and New Zealand Audit of Surgical Mortality is funded by state and territory health departments and managed through Royal Australasian College of Surgeons. Funders have not played any role in the conceptualisation collection, extraction, analysis or the opinions expressed in this report.

Author information

Authors and Affiliations

  1. Royal Australasian College of Surgeons (RACS), Melbourne, Australia

    Dylan Hansen, Franca Itotoh & Kopunic Helena

  2. Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia

    R. James Aitken

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  1. Dylan Hansen
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  3. Kopunic Helena
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the Australian and New Zealand Audit of Surgical Mortality

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Correspondence to R. James Aitken.

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Conflict of interest

None of the authors have a conflict of interest.

Ethics and informed consent

The activities of ANZASM receive protection under the Commonwealth Qualified Privilege Scheme, under part VC of the Health Insurance Act 1973 under which it has ethical approval as a declared Quality Assurance Activity.

Meeting presentations

This work was presented at the Royal Australasian College of Surgeons Annual Scientific Congress on 2nd May 2023.

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Supplementary Information

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Figure S1

SMR for all surgical mortalities deaths under a surgeon in each state and territory by year based on each state’s own population. The index year for each state is shown by the orange square and line. (JPG 438 kb)

Figure S2

SMR for all surgical mortalities deaths under a surgeon shown nationally and for each state and territory based on the national population. The index year is based on the national population and shown by the orange square and line. (JPG 407 kb)

Figure S3

SMR for all mortalities deaths under a surgeon for each surgical specialty shown nationally and based on the national population. The index year is based on the national population and shown by the orange square and line. (JPG 470 kb)

Figure S4

SMR for non-operative mortalities deaths under a surgeon in each state and territory by year based on each state’s own population. The index year for each state is shown by the orange square and line. (JPG 479 kb)

Supplementary file 5 (DOCX 13 kb)

Supplementary file 6 (DOCX 14 kb)

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Hansen, D., Itotoh, F., Helena, K. et al. Observations from Australia’s National Surgical Mortality Audit. World J Surg 47, 3140–3148 (2023). https://doi.org/10.1007/s00268-023-07205-z

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