There has been an upward trend in surgical deaths in WA since 2020 with non-technical skills playing part, according to a new report.
The Western Australian Audit of Surgical Mortality (WAASM) released this week found many issues relating to surgical mortalities in the state last year were due to non-technical skills such as communication and leadership, rather than the surgical procedures themselves.
The report from the Royal Australasian College of Surgeons’ (RACS) also found that the upward trend in surgical deaths observed since 2020 had continued.
A total of 695 deaths were recorded in WA where a patient died having been under the care of a surgeon, regardless of whether an operation was performed. Or had been under the care of a physician and subsequently underwent a surgical procedure.
That number has steadily increased each year from 2020, when 534 such deaths were recorded.
WAASM Clinical Director Dr James Aitken told Medical Forum the rise had been driven by deaths in general surgery, which accounted for about 40% of deaths.
“The rise is probably indirectly related to COVID, people presenting later, not having their routine medical checks,” he said.
“It’s been said for years, one of the consequences of COVID will be that people don’t have screening procedures, they don’t have their colonoscopies, they’re not screening for diabetes, they don’t have their cardiac studies, and this is the result.
“It’s kind of what you’d expect, they’re the older, frailer population that are going to be more likely to come in under general surgery.
“If they’re impacted by COVID, they’re more likely to come under a general surgery than say orthopaedics or neurosurgery.”
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The audit aims to continuously improve surgical care by providing an independent, external clinical review of all patients who die under the care of a surgeon, regardless of whether there was an operation.
Dr Aitken said the message for the surgical community was clear: “If people have had COVID in the past, you just need to be aware that they’re probably slightly higher risk and again there’s good evidence to support that.”
Meanwhile, he said the increase in the number of deaths in surgical patients who did not have an operation was likely in relation to the avoidance of non-beneficial surgery.
As with previous reports, many of the clinical management issues identified in this latest audit were unrelated to the technical aspects of surgery but instead related to non-surgical issues such as communication or leadership.
Dr Aitken said these results mirrored data from two papers recently published by the Australian and New Zealand Audit of Surgical Mortality.
“The focus of people when they look at a surgery if things don’t go right is that they assume it’s a technical error related to some aspect of the operation itself, but the data that we’ve got shows actually a far greater problem is what would be known as the non-technical errors,” he told Medical Forum.
“Things like, was the consultant supervision appropriate? Was there a delay in managing the patient because of poor communication? Or was it because a test wasn’t done?”
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He said there was a definite need for more training around these soft aspects of care.
“The question is, is that led by the College or is it led by the health department? Many of these problems are not related to surgeons – if a patient comes into ED and isn’t appropriately supervised and that patient then dies because the surgery is delayed, the skill failure wasn’t in the surgical community, it was in the ED community,” he added.
“We can give lots of examples where the patient may die under the surgeon, but the cause of the problem isn’t the surgeon, it’s some other part of the health system.
“So, it’s not just a question of saying we want the surgical college to look into this, it’s a much bigger picture than that.”
A spokesperson for WA Health said the report continued to provide valuable insights that support continuous improvement in clinical practice and patient outcomes.
However, the department did not say if the latest report would prompt renewed action to address some of the skill failures that were shown to be a factor in surgical mortalities in the state. Instead they pointed to work already underway.
“To strengthen system-wide capability, the Department of Health has introduced the Safety and Quality Workforce Capability Framework, which outlines six domains central to clinical excellence, including effective clinical communication,” they said.
“In addition, statewide e-learning modules launched in November 2024 are helping build capability across WA Health, supported by a broader program aimed at embedding quality improvement and patient safety principles into everyday practice.”
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