Steps towards national post-surgery mortality review system

15 February 2012

First steps towards national post-surgery mortality review system

Having a better understanding of deaths that occur in the days and weeks following surgery and anaesthesia will help reduce harm to patients, says the Chair of the Health Quality & Safety Commission.

Professor Alan Merry has received the inaugural report of the Perioperative Mortality Review Committee (POMRC) and says it is the first of its kind in New Zealand. The POMRC is an independent mortality review committee that advises the Health Quality & Safety Commission on how to reduce the number of perioperative deaths in New Zealand. More information about its purpose and functions can be found at www.hqsc.govt.nz.

The inaugural report provides an overview of what is known about perioperative mortality in New Zealand, identifies gaps, and is a starting point for the development of a national perioperative mortality review system.

“This is something clinicians have wanted for a long time and the whole-of-system approach to the issue being taken by POMRC is internationally innovative,” says Professor Merry.

Between 4000 and 5000 patients die following any form of surgical procedure and anaesthesia each year in New Zealand. Outgoing POMRC Chair, Professor Iain Martin, says that in many cases the operation itself played no part in the patient’s death.

“In a small number of cases, however, there are lessons to be learned that can help improve the quality of health care delivery in New Zealand. This report identifies ways to provide information to help health and disability services understand what is happening,” he says.

The new Chair of POMRC, Dr Leona Wilson, says the report provides valuable insights into perioperative mortality and will help the POMRC build on the advances already made in this area.

For its inaugural report, the POMRC looked at national data collections to better understand the information currently collected and to make recommendations that can enhance existing systems so that a report for the entire health care system can be generated. The National Minimum Dataset and National Mortality Collection were analysed for the years 2005 to 2009, looking at four main areas of activity: hip and knee arthroplasty, colorectal resection, cataract surgery and anaesthesia.

Arthroplastymeans the surgical repair of a joint.

A colorectal resection is surgery to remove sections of the large intestine. This happens to remove injured or diseased parts of the colon.

The report’s main conclusion was a recommendation that building upon existing data collections will enable the establishment of a whole-of-health care system mortality review process and that the work of the committee for the coming years will drive these developments.

Specific findings from the data analysis indicated that overall mortality rates for the areas considered were comparable with similar international reports.

For hip replacement surgery, 0.24 percent of patients died within 30 days of admission for an elective (routine) operation For patients admitted as an emergency, usually following a hip fracture, 7.3 percent died within 30 days of surgery.

For elective colorectal resection, 2.1 percent of patients died within 30 days of surgery. For acute colorectal operations the mortality rate at 30 days was 9.8 percent.

Analysis shows that 0.2 percent of patients admitted for cataract surgery died within 30 days of the operation, with most deaths occurring after the person had been discharged from hospital. Heart attacks and other types of heart disease were most frequently listed as the cause of death.

Data on more than 1.1 million general anaesthesics were reviewed (68 percent of these being elective procedures). Mortality was assessed the same or the next day to compare with international data and to minimise the confounding effects of subsequent anaesthesia procedures within 30 days. Following 792,614 elective general anaesthetics, there were 177 deaths (0.02 percent), with just under half due to heart attacks or other cardiovascular causes. Same or next day mortality following general anaesthetic had an initial peak in children aged zero to four, dropped for those aged five to nine, and then increased with increasing age. Mortality following general anaesthesia was higher for acute admissions across all age groups.

The POMRC is recommending the development of a national perioperative mortality review process which builds on and enhances the mortality data already collected. It is also suggesting a formal memorandum of understanding between the POMRC and Coronial Services to ensure access to data, working closely with the National Health Board to enhance and standardise existing mortality data collections. As well, it would like to see mandatory submission of data by all healthcare facilities.

Professor Merry says the Commission’s Board will consider these recommendations and make a decision about next steps by the end of June.

The full report, and a questions and answers document, is available on the Commission’s website: www.hqsc.govt.nz

ENDS