Analysis of surgical mortality in rural South Australia: a review of four major rural hospital in South Australia.

Publisher: Wiley-Blackwell Publishing Asia Country of Publication: Australia NLM ID: 101086634 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1445-2197 (Electronic) Linking ISSN: 14451433 NLM ISO Abbreviation: ANZ J Surg Subsets: MEDLINE

Publication: Carlton, Victoria, Australia : Wiley-Blackwell Publishing Asia
Original Publication: Carlton, Victoria, Australia : Blackwell Science Asia on behalf of the Royal Australasian College of Surgeons, c2001-

Colorectal Neoplasms* ; Pneumonia, Aspiration* ; Rural Health Services*; Aged ; Aged, 80 and over ; Australia ; Hospitals, Rural ; Humans ; Multicenter Studies as Topic ; Rural Population ; South Australia/epidemiology

Background: One-third of Australia's population reside in rural and remote areas. This audit aims to describe all-causes of mortality in rural general surgical patients, and identify areas of improvement.
Methods: This is a retrospective multi-centre study involving four South Australian hospitals (Mt Gambier, Whyalla, Port Augusta, and Port Lincoln). All general surgical inpatients admitted from June 2014 to September 2019 were analysed to identify all-cause of mortality.
Results: A total of 80 mortalities were recorded out of 26 996 admissions. The overall mortality rate of 0.3% was the same as the 2020 Victorian state-wide Audit of Surgical Mortality. No mortality was secondary to trauma. Mean age was 79 ± 11 years and ASA was 3.9 ± 1. Malignancy was associated in over a third of cases (41.2%), mostly colorectal and pancreatic. Most cases were related to general surgical subspecialties: colorectal (51.3%), upper gastrointestinal (21.3%), hepatopancreaticobiliary (13.8%); however, there were also vascular (6.3%) and urology (3.8%) cases. The most common causes of mortality were large bowel obstruction (13.4%), ischemic bowel (10.4%), and small bowel obstruction (7.5%). Majority of mortality were beyond the surgeon's control (73.8%). Of the 21 potentially preventable mortalities, 42.9% were attributed to aspiration pneumonia and decompensated heart failure. Only one (1.3%) mortality case was due to pulmonary embolism.
Conclusion: Rural general surgical mortalities occur in older, comorbid patients. Rural surgeons should be equipped to manage basic subspeciality conditions. To further reduce mortalities, clear protocols to prevent aspiration pneumonia and resuscitation associated fluid overload are needed.
(© 2022 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)

Urology. 1999 Dec;54(6A Suppl):8-14. (PMID: 10606278)
BMC Pediatr. 2018 Jun 26;18(1):207. (PMID: 29945586)
J Surg Res. 2020 Jan;245:629-635. (PMID: 31522036)
Transfus Med Rev. 2013 Apr;27(2):105-12. (PMID: 23465703)
Aust J Rural Health. 2009 Feb;17(1):2-9. (PMID: 19161493)
J Endovasc Ther. 2014 Aug;21(4):568-75. (PMID: 25101588)
Aust J Rural Health. 2018 Dec;26(6):408-415. (PMID: 30474225)
Medsurg Nurs. 2012 Sep-Oct;21(5):303-8. (PMID: 23243789)
Am J Surg. 1990 Aug;160(2):197-201. (PMID: 2200293)
J Vasc Surg. 1990 Jul;12(1):41-4. (PMID: 2374253)
Crit Care Med. 1990 Jul;18(7):728-33. (PMID: 2364713)
ANZ J Surg. 2019 Jul;89(7-8):833-841. (PMID: 30790425)
Intern Med J. 2012 Jun;42(6):698-708. (PMID: 22697152)
Crit Care Nurse. 2011 Oct;31(5):38-45. (PMID: 21965382)
Best Pract Res Clin Anaesthesiol. 2006 Sep;20(3):439-55. (PMID: 17080695)
ANZ J Surg. 2019 Jun;89(6):666-671. (PMID: 31083814)
Aust Health Rev. 2014 Feb;38(1):70-9. (PMID: 24480646)

Keywords: general surgery; hospital mortality; rural population

Date Created: 20220608 Date Completed: 20220812 Latest Revision: 20221015

20231215

PMC9546185

10.1111/ans.17833

35674399