Impact of consultant operative supervision and surgical mortality in Australia

Abstract

Background: In this study, the Australian and New Zealand Audit of Surgical Mortality evaluated the effect of operative supervision on certain post-operative outcomes in the surgical death subset. Methods: This retrospective cohort study was based upon mortality data collected in 2009 which included 1673 patients who died and had surgery within 30 days of death or during the last admission. Cases were divided into three groups: consultant not supervising (group NS), consultant supervising (group S) and consultant performing the operation (group C). A comparison was done nationally and between participating states in Australia. Certain post-operative outcomes were compared between the three groups as well as between elective and emergency operations. Results: There were significant variations in the levels of operative supervision among states in Australia. Group NS (n = 468) generally had more favourable postoperative outcomes than group S (n = 147) and group C (n = 1058), with post-operative complication rates of 24.8%, 37.4% and 40.9% for groups NS, S and C, respectively. The level of operative supervision in emergency operations was half that of elective operations. Nevertheless, the post-operative complications rate was significantly lower in emergency operations (30.6%) compared with elective operations (64.4%). The same trend was seen with clinical management deficiencies and unplanned return to theatre. Conclusion: Operative supervision in emergency setting within Australian hospitals appears to be potentially inadequate. However, the available data suggest that unsupervised surgery did not result in worse post-operative outcomes. In appropriately selected cases, the data support surgical registrars performing surgery without consultant supervision.

Post-graduate surgical training in Nigeria: The trainees′ perspective

“…Technical competency, however, is just an aspect of what makes a good surgeon; surgery further requires an integration of higher-order cognitive skills derived from interaction with medical texts, journals, teaching rounds and lectures to make good clinical decisions 222. Good clinical judgment is needed before, during and after surgery because most of the highly preventable adverse surgical events are errors of poor judgment rather than the actual procedures 23. This underlines a need for constant sponsorship and educational supports for trainees’ professional development.…”

Fatal flaws in clinical decision making

“…The decision to operate was identified as the most common CDMI. Interestingly, the decision to operate involved a consultant in over 90% of cases of patient death in a previous Australian study analysing post‐operative death in 2009 . This rate of consultant involvement seems adequate, and achieving a higher rate in Australia is unlikely to be feasible with senior registrars performing many minor operations in Australian hospitals.…”

“…A previous ANZASM review concluded that operative supervision in the emergency setting was inadequate in some cases. It demonstrated service registrars (registrars in non‐training positions) to have operated on 13% of cases unsupervised, with only 62.3% of all operations involving consultant supervision across the country . Senior surgeon supervision is integral for inexperienced junior staff to ensure that complex clinical decision making is not compromised in the operating theatre.…”

The Australian and New Zealand Audit of Surgical Mortality—Birth, Deaths, and Carriage

“…Initial publications based on the SASM described deaths due to inadequate deep venous thrombosis prophylaxis 9 and large bowel operations with delay in diagnosis, treatment, and low consultant input. 19 From the data already obtained from the Australian audits, there have been publications on the impact of consultant operative supervision on mortality 20 and an analysis of the causes and effects of delay before diagnosis. 16,17 They have also observed a reduction in adverse events, greater levels of consultant input, and better high dependency unit usage.…”