Delegates attending the Royal Australasian College of Surgeons Annual Scientific Congress this week will hear how the College’s surgical quality programme that reviews death under a surgeon has been associated with a substantial reduction in deaths.
Australia is the only country with a national surgical mortality audit - the Australian and New Zealand Audit of Surgical Mortality (ANZASM). This audit ensures that every patient in Australia who dies in hospital under a surgeon, whether they had an operation or not, undergoes an independent, anonymous, and external peer review by another surgeon.
Such external review is normal practice in any safety critical industry, but not in medicine. ANZASM commenced in 2002 in Western Australia and has included all states since 2011 and has been part of the College’s Continuous Professional Development programme since 2013.
The first presentation reported that the Standardised Mortality Ratio (SMR), a standard methodology used around the world to track changes in mortality, has shown a significant fall in deaths under a surgeon in all states and territories and in all surgical specialties. The reduced mortality, typically twenty percent or more over the last five years and even greater for states that joined ANZASM earlier, is a reflection of the education provided to surgeons through self-reflection, patient specific independent, external review and shared learning through reports and symposia.
The second presentation is based on a national pilot study accessing the outcome reported mortality following very high-risk emergency major abdominal surgery – The Australian and New Zealand Emergency Laparotomy Audit (ANZELA). This has shown the mortality after an emergency laparotomy in Australia is around seven percent, at least one third less than reported internationally. This represents an estimated 500 Australian lives saved every year.
An important difference between Australia and overseas studies is the avoidance of an emergency laparotomy in extremely high-risk patients in whom survival is unlikely and for those who do leave hospital is associated very often associated with poor quality of life. This has been a strong focus of the ANZASM for many years.
Chair of the ANZELA working party, Dr James Aitken, will present at the conference and said the results demonstrated the enormous benefit that can be gained from investing in Clinical Quality Registries.
“The ANZASM and ANZELA are a practical demonstration of the College’s strong commitment to Clinical Quality Registries. The College strongly endorses the Australian Commission for Safety and Quality in Health Care revised Framework for Australian Clinical Quality Registries released for discussion in January 2023.
“Both ANZASM and ANZELA have clearly demonstrated how relatively modest funding of Clinical Quality Registries will result in much improved outcomes for patients. The Commission’s own work has demonstrated that they result in long term financial savings.
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