Surgery in WA has never been safer, according to the latest report from the Royal Australasian College of Surgeons.
The Western Australian Audit of Surgical Mortality (WAASM), released 13 October 2022, showed that except for an increase in 2021, the rate of deaths under the care of a consultant surgeon per 100,000 people in WA decreased between 2017 and 2020.
From 1 January 2017 to 31 December 2021, there were 2,912 deaths reported, of which, 2,803 met WAASM criteria for inclusion: general surgery reported the most deaths at 43.1% (1,207), followed by neurosurgery and orthopaedic surgery at 16.9% (474) and 16.9% (473) respectively.
Other key results for the period included:
- 67.0% of patients had one or more operations
- 30.2% of patients had a preoperative transfer
- 85.2% of cases had one or more comorbidities present
- 29.0% of cases had a clinically significant infection
For the last 20 years, WAASM has provided an independent, peer-reviewed assessment of surgery-related deaths to improve patient outcomes, and to mark the occasion, this year’s report also included a detailed assessment of data from the audit’s results over the last two decades.
From 713 and 740 deaths per year in 2005 and 2006, there was a fall of 18.5%, to 592 deaths in 2012, that has since plateaued. When corrected for the greater population, the number of deaths has continued to fall over 20 years, from 34.7 to 22.0 deaths per 100,000 people, a decrease of 36.6%.
WAASM Clinical Director, Dr James Aitken, said the data shows a significant reduction in the number of surgical deaths since the audit’s inception, and while some of the observed improvements reflect developments in practice, others reflect the direct impact of the audit – highlighting the value of the 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,” Dr Aitken said.
“We have seen year on year falls in the number of deaths per 100,000 population, 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 20-year data was also dominated by general surgery, which was responsible for 41.9% of all deaths (5,147 out of 12,280). In the early years, there were an average of 37 deaths per annum following an elective general surgery admission, but over the last four years this has reduced to 16.
The average number of postoperative orthopaedic deaths per annum has progressively fallen from 81 to 61 over the last two decades and during this time, deaths associated with vascular surgery peaked in 2007 and 2008 for operative and nonoperative cases respectively, before exhibiting a 15.8% reduction for the 10-year period post 2012.
Dr Aitken pointed out that even though WAASM was the first of its kind in Australia when it initially piloted in 2001 under the management of UWA, audits now exist in every state and territory and have continued to evolve and improve over time.
“The success of this WA program has led to safer surgery across the whole nation,” Dr Aitken said.
“In an era of rationalisation, it is hard to remember a time where health care budgets have been under as much pressure and 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.”
Dr Aitken also raised the fact that long COVID will develop in at least 15% of infected patients and there is the potential for the condition to adversely affect surgical outcomes.
“It is important we maintain this investment in safety and quality, particularly in the context of the pandemic,” he said.
“Until early 2022, WA had minimal infections and WAASM is not aware of any surgical patient who had died directly or indirectly from COVID… The audit will play an important role in providing data on any trends that manifest.”
Further information on this topic will be featured in next month’s upcoming edition of the Medical Forum Magazine – make sure you get your copy to find out more!