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Obesity and infection control highlighted as priorities

Obesity and infection control highlighted as priorities in latest surgical audit report
Tuesday 22 November, 2016

The 7th National Report of the Australian and New Zealand Audits of Surgical Mortality (ANZASM) was released today by the Royal Australasian College of Surgeons (RACS), which highlighted an increase in obesity as a comorbidity, as well as recommending postoperative infection control as an area for improvement.

The ANZASM 2015 Report, involving the clinical review of all cases where patients had died while under the care of a surgeon, showed that since the last report obesity had gradually overtaken hepatic (liver-related) issues as an increasingly observed comorbidity.

RACS recently issued a warning that an obesity epidemic was already upon us, which the Chair of ANZASM, Professor Guy Maddern, said was beginning to be reflected in the audit process.

“When we first started gathering national data on obesity in 2009, the incidence of obesity as a comorbidity for surgical mortality was approximately 2 per cent. By the end of 2015, it was 4 per cent,” Prof Maddern said.

“Obesity still ranks behind other comorbidities in terms of its prevalence but the increase shown in the audit is noteworthy.

“Obese patients are much more likely to present with multiple comorbidities, and as a result are at greater risk of experiencing complications or adverse outcomes during and after surgery.”

Prof Maddern said that the increase in surgeon participation since the audit’s inception nationwide in 2009 has allowed for a much higher quality of information and for trends in data to be identified over time.

“Since we first began conducting the audit across Australia and New Zealand in 2009, the number of surgeons participating in the process has increased from 60 per cent to almost 98 per cent. We have access to much more comprehensive data that allows us to make more accurate longitudinal comparisons over time".

"This not only helps us to self-regulate our profession, but also allows for valuable information to be made available to researchers and policy makers, as we have seen with the obesity example in this report”

The report also recommended a renewed focus on infection control, following a 3 per cent rise in the number of clinically significant infections over the past two years. The increase was largely driven by a rise in the number of infections during a patient’s admission, and Prof Maddern said there remained scope to strengthen existing practices as there were regional variations.

“We first began collecting data on infection in patients undergoing surgery in 2012, and we are now at a point where we can begin to identify trends and implement strategies to prevent and minimise infections contracted both prior to and during surgery.”

“Surgical patients, particularly those with certain comorbidities, are more susceptible to developing infection”.

Prof Maddern said other key highlights from the 2015 report included:

• The proportion of cases with adverse events has remained relatively static (3.6 per cent in 2012 compared to 3.4 per cent in 2015).

• The most common issues experienced were delays related to the transfer (40 per cent), inappropriateness of transfer (22%) and insufficient clinical documentation (17 per cent).

• In the majority of instances those patients expected to benefit from critical care support did receive it. The review process suggested that 7 per cent of patients who did not receive treatment in a critical care unit would most likely have benefited from it.

• Fluid balance in the surgical patient is an ongoing challenge; however the report highlights improvements are being made in this area.

• The audit revealed that patients admitted as surgical emergencies have a greater risk of falling while in hospital. All health professionals should increase their awareness of this risk to improve the quality and safety of patient care.

• Participation in the audit has increased significantly over time, and from 2017, the Australian Orthopaedic Association will make it compulsory for its members to partake.

Managed by RACS and funded by the state and territory departments of Health, the ANZASM presents the outcome of clinical reviews conducted into 23,292 deaths that completed the full audit process from 1 January 2009 to 31 December 2015.

The 2015 ANZASM Report is available on the RACS website:


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