Report sheds light on surgery-related deaths

27 Mar 2013 | Perioperative Mortality Review Committee

A new report out today sheds light on the death rates from four areas of surgery and anaesthesia, and recommends improvements to the way patients are assessed for risk.

The Perioperative Mortality Review Committee (POMRC) has released its second report to the Health Quality & Safety Commission (the Commission), and this is available from the Commission’s website.

The POMRC, which operates under the umbrella of the Commission, reviews deaths related to surgery and anaesthesia which occur within 30 days of an operative procedure.

The Chair, Dr Leona Wilson, says it is reported that an estimated 230 million-plus major surgical procedures are carried out around the world each year, but the risks of death related to surgery and anaesthesia are still not well known.

“We wanted to contribute to the health sector’s knowledge of mortality rates and further understand the strengths and weaknesses of the national data sets we were drawing information from,” says Dr Wilson.

Professor Alan Merry, Commission Chair, welcomes the report.

“Understanding the risks associated with surgery is essential for assisting patients in making appropriate choices between health care options, for improving the safety of surgery and for ensuring that the best value is obtained from the resources invested in health care,” he says.

“For example, this report illustrates the tragedy and waste of valuable resource that occurs when a patient dies from a pulmonary embolism that could potentially have been prevented.”

The POMRC report drew on data from the National Mortality Collection and the National Minimum Dataset to examine death rates in four clinically important areas:

  • cholecystectomy (surgical removal of the gallbladder) - death rate of 1 percent for acute admissions and 0.16 percent for elective admissions within 30 days
  • pulmonary embolism – death rate of 0.05 percent for acute admissions and 0.008 percent for elective patients who had surgery / anaesthesia and developed pulmonary embolism
  • patients aged 80 or over (a high-risk group) – death rate of 9 percent within 30 days post emergency surgery. Where the surgery was planned, the death rate dropped significantly to 1.2 percent
  • elective patients, categorised as low risk – death rate of 0.07 percent within 30 days post-surgery for all ages, although for those aged 0 to 24 years, for example,  a death rate of 0.01 percent within 30 days post-surgery.

Dr Wilson says these figures are comparable with what is happening overseas, although comparisons for all categories can be difficult as there are few, if any, whole-of-system perioperative mortality review systems.

The report also looked at the use of coronial files in investigations of perioperative mortality, and confirmed the important place of this information in understanding surgical deaths.

It also plans to discuss the report’s findings at its inaugural workshop in Wellington in June.

“We’re hoping these findings will help patients and their doctors and nurses make the best possible decisions about their care,” says Dr Wilson.

The POMRC report makes a number of recommendations, including:

  • formal assessment of all patients preoperatively for risk of venous thromboembolism
  • active participation by all health care professionals in the WHO Surgical Safety Checklist
  • ensuring information is available to patients about the risks of dying within 30 days of any procedure with a significant risk of mortality
  • further development of non-operative care pathways, and use of these when surgical procedures are considered too risky.

The Committee is developing a system to support reporting of information, peer review and further in-depth understanding of the causes of perioperative mortality. The data collection system to be developed will take account of existing processes.

“We recognise that data collection can impose burdens on individual clinicians, and it is our intention to minimise that by using data already collected as a basis for clinician reports,” says Dr Wilson.

Last updated 27/03/2013