Surgery in Western Australia (WA) has never been safer, according to the latest report of the Royal Australasian College of Surgeons’ (RACS) Western Australian Audit of Surgical Mortality (WAASM).

To mark 20 years of existence, this year’s report includes a detailed assessment of data from the audit’s clinical reviews of surgical deaths over the past two decades. The results showed a significant reduction in the number of surgical deaths since the audit’s inception. Audit Clinical Director, Dr James Aitken said the reduction over time was pleasing and highlighted the value of the audit process.

“The proof is in the numbers - audits work! After two decades, we now have a significant amount of data available to identify long term trends and make comparisons. We have seen year on year falls in the number of deaths per 100,000 population, this has fallen to the point where the number of deaths is almost half what it was when we first began. This is despite our ageing population.”

The audit involves the independent clinical review of all cases where patients died while under the care of a surgeon and is aimed at the ongoing improvement of surgical care. External clinical reviews are conducted by surgeons who practice in the same specialty but are from a different hospital.

WAASM was the first audit of its kind in Australia when it initially piloted in 2001 under the management of the University of Western Australia. In 2005, management of WAASM transferred to RACS, with funding provided by the state government. Audits now exist in every Australian state and territory and have continued to evolve and improve over time.

“In an era of rationalisation, it is hard to remember a time where health care budgets have been under as much pressure. The audit is a classic demonstration that sometimes the best way of saving money is not necessarily to always look for immediate cost savings, but to invest and obtain sustainable long-term improvements.

“The success of this WA program has led to safer surgery across the whole nation. It is important we maintain this investment in safety and quality, particularly in the context of the COVID-19 pandemic.

“Until early 2022, WA had minimal COVID-19 infections and WAASM is not aware of any surgical patient who had died directly or indirectly from COVID-19. The audit will play an important role in providing data on any trends that manifest”.

Other key findings from the WAASM report include:

  • The number of deaths under a surgeon without an operation has increased, suggesting the limitations of performing certain types of surgery on the very old and frail are being recognised.
  • A postoperative complication occurred in 28.8 per cent of operative patients (437/1,515) between 2017 and 2021. The most frequently reported postoperative complications were postoperative bleeding, tissue ischaemia and sepsis. This data makes a strong case for a consultant surgeon to be present when a patient is returned to theatre for postoperative bleeding.
  • The majority of patients (85.2 per cent) had at least one comorbidity. Age (61.8 per cent) and cardiovascular disease (61.6 per cent) were the most common comorbidities.
  • There is an increasing number of patients having non-surgical invasive procedures. These deaths also need to undergo the same level of scrutiny as surgical procedures reviewed through the audit.


View the full WAASM report

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