Perioperative Mortality Rates in Australian Public Hospitals: The Influence of Age, Gender and Urgency
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A decline in surgical deaths has been observed in Australia since the introduction of the Australian and New Zealand Audit of Surgical Mortality (ANZASM). The current study was conducted to determine whether the perioperative mortality rate (POMR) has also declined.
This study is a retrospective review of the POMR for surgical procedures in Australian public hospitals between July 2009 and June 2013, using data obtained from the Australian Institute of Health and Welfare. Operative procedures contained in the Australian Refined Diagnosis Related Groups were selected and the POMR was modelled using urgency of admission, age and gender as explanatory covariates.
The POMR in Australian public hospitals reduced by 15.4 % over the 4-year period. The emergency admissions POMR dropped from 1.40 to 1.12 %, and the elective admissions POMR from 0.09 to 0.08 %. The binary logistic regression model used to predict patient mortality showed emergency admissions to have a higher POMR than elective, being more evident at older ages. For emergency admissions, the difference in POMR between females and males increased with age, from about 55 years onwards, with females being lower. For elective surgeries, the difference between males and females was of little practical importance across ages.
The reduction in the POMR in Australia confirms the reduction in surgical deaths reported to ANZASM. Continuing to monitor POMR will be important to ensure the safest surgery in Australia. Further investigations into case-mix will allow better risk adjustment and comparison between regions and time-periods, to facilitate continuous quality improvement.
KeywordsPublic Hospital Emergency Admission Binary Logistic Regression Model Surgical Mortality Elective Admission
Claudia Retegan and Gordon Guy are thanked for their assistance in obtaining the data from AIHW.
None to disclose.
Compliance with ethical standards
Conflict of Interest
None to disclose.
- 3.World Alliance for Patient Safety (2008) WHO surgical safety checklist and implementation manual. www.who.int/patientsafety/safesurgery/ss_checklist/en/. Accessed Nov 2015
- 6.Perioperative Mortality Review Committee (2014) Progress report of the Perioperative Mortality Review Committee. www.hqsc.govt.nz/assets/POMRC/Publications/POMRC-progress-report-Mar-2014.pdf. Accessed Nov 2015
- 13.Royal Australasian College of Surgeons (2014) Australian and New Zealand Audit of Surgical Mortality National Report 2014. www.surgeons.org/media/21156102/2014-11-25_rpt_anzasm_annual_report_2013.pdf. Accessed Nov 2015
- 14.Australian Institute of Health and Welfare (2015) Separation mode code N. Available from http://meteor.aihw.gov.au/content/index.phtml/itemId/270688 Accessed Jan 2016
- 15.The R Core Team (2015) R: a language and environment for statistical computing. Available from www.cran.r-project.org/doc/manuals/r-release/fullrefman.pdf Accessed Nov 2015
- 16.Harrell Jr F (2015) RMS: regression modeling strategies. Available from www.cran.r-project.org/web/packages/rms/index.html Accessed Nov 2015
- 20.Department of Health and Human Services (2015) Victorian admitted episodes dataset (VAED). Available from www.health.vic.gov.au/hdss/vaed/ Accessed Nov 2015
- 21.Australian Institute of Health and Welfare (2014) Australian hospital statistics 2013–14. AIHW, CanberraGoogle Scholar