Mortality in Australian cardiothoracic surgery: findings from a national audit.
Date
2020
Authors
Chan, J.C.Y.
Gupta, A.K.
Stewart, S.K.
McCulloch, G.A.J.
Babidge, W.J.
Worthington, M.G.
Maddern, G.J.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
Annals of Thoracic Surgery, 2020; 109(6):1880-1888
Statement of Responsibility
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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.