Mortality in Australian Cardiothoracic Surgery: Findings From a National Audit

Chan, Justin; Gupta, Aashray K.; Stewart, Sherry; McCulloch, Glenn A. J.; Babidge, Wendy; Worthington, Michael; Maddern, Guy J.

doi:10.1016/j.athoracsur.2019.09.060

Cited by 22 publications

(26 citation statements)

References 28 publications

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“…35 It is likely that the cohort studied represents cases of urgent and emergency surgery that could not otherwise be postponed, which has also been shown as a risk factor for poorer post-operative outcomes. 36,37 Although not shown in our study, issues within hospitals and health systems may also contribute to this finding, as available resources may have been diverted to treat other COVID-19 patients.…”

Section: Discussionmentioning

confidence: 65%

“…Myocardial damage from infection may represent one large factor, combined with the physiological and inflammatory stresses associated with cardiopulmonary bypass, need for mechanical ventilation and ischaemia reperfusion 35 . It is likely that the cohort studied represents cases of urgent and emergency surgery that could not otherwise be postponed, which has also been shown as a risk factor for poorer post‐operative outcomes 36,37 . Although not shown in our study, issues within hospitals and health systems may also contribute to this finding, as available resources may have been diverted to treat other COVID‐19 patients.…”

Section: Discussionmentioning

confidence: 77%

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Cardiac surgery on patients with COVID‐19: a systematic review and meta‐analysis

Gupta

Leslie

Hewitt

et al. 2022

ANZ Journal of Surgery

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Introduction:The COVID-19 pandemic has had a significant impact on global surgery. In particular, deleterious effects of SARS-CoV-2 infection on the heart and cardiovascular system have been described. To inform surgical patients, we performed a systematic review and meta-analysis aiming to characterize outcomes of COVID-19 positive patients undergoing cardiac surgery. Methods: The study protocol was registered with PROSPERO (CRD42021228533) and conformed with PRISMA 2020 and MOOSE guidelines. PubMed, Ovid MEDLINE and Web of Science were searched between 1 January 2019 to 24 February 2022 for studies reporting outcomes on COVID-19 positive patients undergoing cardiac surgery. Study screening, data extraction and risk of bias assessment were conducted in duplicate. Meta-analysis was conducted using a random-effects model where at least two studies had sufficient data for that variable. Results: Searches identified 4223 articles of which 18 studies were included with a total 44 patients undergoing cardiac surgery. Within these studies, 12 (66.7%) reported populations undergoing coronary artery bypass graft (CABG) surgery, three (16.7%) aortic valve replacements (AVR) and three (16.7%) aortic dissection repairs. Overall mean postoperative length of ICU stay was 3.39 (95% confidence interval (CI): 0.38, 6.39) and mean postoperative length of hospital stay was 17.88 (95% CI: 14.57, 21.19). Conclusion: This systematic review and meta-analysis investigated studies of limited quality which characterized cardiac surgery in COVID-19 positive patients and demonstrates that these patients have poor outcomes. Further issues to be explored are effects of COVID-19 on decisionmaking in cardiac surgery, and effects of COVID-19 on the cardiovascular system at a cellular level.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 77%

Cardiac surgery on patients with COVID‐19: a systematic review and meta‐analysis

Gupta

Leslie

Hewitt

et al. 2022

ANZ Journal of Surgery

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“…As a national audit, ANZASM is designed to audit cases from a range of specialties each with individual peculiarities. Many of the general findings are applicable to other surgical specialties, which may benefit from similar qualitative analysis of mortality data.…”

Section: Discussionmentioning

confidence: 85%

“…Improved surgical outcomes have been derived from audit participation, with observed changes in practice . Specific management issues have been identified through this process in other surgical specialties such as neurosurgery and cardiothoracic surgery, and more broadly across surgery in general …”

Section: Introductionmentioning

confidence: 99%

Potentially avoidable issues in urology mortality cases in Australia: identification and improvements

Gupta

Stewart

Cottell

et al. 2020

ANZ Journal of Surgery

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Background: This study aimed to identify the most common potentially avoidable factors in urology deaths, focusing on the lessons that can be learnt. Methods: This study analysed data from a well-established and comprehensive peer review audit of surgical deaths in Australian hospitals (excluding New South Wales) from 2009 to 2015, focusing on urology cases with identified areas for improvement in patient management. Of all audited deaths, 11% (79/719) had serious clinical management issues with a total of 109 individual clinical management issues identified. These were categorized based on perioperative stage (preoperative, intraoperative or post-operative), followed by thematic analysis within each stage. Results: The study found preoperative issues to be the most common (n = 48), followed by post-operative issues (n = 32) with intraoperative issues less common (n = 13). Communication issues were seen at all three stages (n = 16). Overall, the most common theme was at the preoperative stage; inadequate preoperative assessment (n = 27). More specifically, the most common preoperative assessment issues involved a failure to order necessary preoperative investigations, or to administer necessary preoperative treatment (e.g. prophylactic antibiotics). The most common communication issue was between teams and at handover, often involving failure by junior medical staff to communicate issues to the responsible surgical consultant. Conclusion: Urological surgical cases with potentially avoidable mortality constitute a small, but important subset of deaths. The analysis of these cases can inform various stakeholders to improve the quality and safety of urological surgical care.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 719-724ANZJSurg.com

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“…9,13 These poorer outcomes have been demonstrated in a range of surgical pathologies and specialties. [5][6][7][8][9] Proposed contributing factors relate to patients (e.g. older age, lower SES), disease (e.g.…”

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confidence: 99%