The surgical burden of disease and perioperative mortality in patients admitted to hospitals in Victoria, Australia: a population-level observational study

Background The geographic region of the South Pacific covers a third of the globe, much of which is ocean, the world's largest geographic feature, spanning 155 km 2. The ocean expanse is scattered with numerous Pacific Island countries and territories (which fall into three main political groups, whose connections are historical, political and/or economic; Table 1). They represent nations generally with small populations but with the least access to safe, affordable and timely surgery in the world, partly as a result of their geography as well as their stage of economic development. This paper describes how the Royal Australasian College of Surgeons (RACS) and the Pacific region have been involved with global surgery and anaesthesia advocacy since 2012. This has included engagement with the World Health Organization (WHO) in Geneva, their Global Initiative for Emergency and Essential Surgery (GIEESC) and WHO's Western Pacific Region Organization (WPRO). The paper focuses on the Pacific Island countries with which RACS, and the Australian and New Zealand College of Anaesthetists (ANZCA), have established relationships and a history of engagement in supporting local agendas for capacity building. The Colleges engage not only in partnership with universities and health departments, but also collaborates with other Australian and New Zealand specialist medical colleges, and their Pacific or Papua New Guinea (PNG) surgical and anaesthesia counterpart associations (Table 2). Although Timor Leste falls outside of the WPRO, the clinical networks and partnerships established through RACS and the other colleges justify including their role in this account of regional advocacy.

Section: Surgical Metrics and Pomrmentioning

confidence: 99%

Advocacy for global surgery: a Pacific perspective

Watters

Tangi

Guest

et al. 2020

“…Originating in 1979, the VAED is a comprehensive data set of the causes, effects and nature of the illnesses reported by the health services in Victoria maintained by the Department of Health and Human Services (DHHS) . The VAED collects a minimum set of data for each admitted patient episode to any hospital in Victoria (both public and private).…”

Section: Introductionmentioning

confidence: 99%

“…It also records the procedures the patient underwent during the admission. Reporting of all admissions to VAED is government requirement and is therefore considered to be highly accurate and free of missing data …”

Section: Introductionmentioning

confidence: 99%

Risk‐adjusted hospital clinical management issue rates using data from the Victorian Audit of Surgical Mortality

Hansen

Retegan

Ismail

et al. 2020

Background: In recent years, there has been a concerted drive for an increase in public reporting of hospital-level outcomes as a means of identifying strategies to improve patient safety. Surgical care, as a high-risk area of medical practice, has come under sharp scrutiny. This study uses data from the Victorian Audit of Surgical Mortality (VASM) in conjunction with data from the Victorian Admitted Episode Dataset to compare hospital rates of clinically identified serious clinical management issues that were definitely or probably preventable and caused or contributed to the death of the patient who would otherwise be expected to survive. Methods: Cases where the date of death was between 1 July 2015 and 30 June 2017 that completed the full VASM audit process were extracted from the VASM database and combined with data extracted from the Victorian Admitted Episode Dataset, where a surgical admission occurred in the same time period. A logistic regression model was used as a method of indirect standardization to derive the probability of preventable clinical management issues, which was then used to calculate the standardized incident rate for all Victorian surgical hospitals. Hospitals were compared by plotting the standardized incident rates on three funnel plots. Results: There were five hospitals (8.3%) of the 60 that deviated significantly from the state-wide rate of 0.00012. Conclusion: The risk adjustment model identified several hospitals that may have a systematic issue which warrant further clinical quality assurance investigation.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 728-733

“…4 Studies from Sweden, USA, Australia and New Zealand have found surgical procedures are performed for 25% to 35% of all hospital admissions. [5][6][7][8] One challenge facing the Pacific Island nations, Papua New Guinea and Timor Leste during the period of implementing the Sustainable Development Goals is to provide access to surgery and anaesthesia care. Such access would reduce the burden of disease that is amenable to surgical treatment, hence would result in improved health and well-being for the Pacific Island populations.…”

Section: Introductionmentioning

confidence: 99%

How will increasing surgical volume affect mortality in the Pacific, Papua New Guinea and Timor Leste?

Nagra

Kaur

Singh

et al. 2020

Background: Nine South Pacific nations, Papua New Guinea and Timor Leste, have collaborated to report and publish their surgical metrics as recommended by the Lancet Commission on Global Surgery (LCoGS). Currently, these countries experience about 750 postoperative deaths per year, representing 1% of crude mortality in the region. Given that more than 400 000 annual procedures are needed in the nine nations to reach the LCoGS target of 5000/100 000, we aimed to calculate the potential contribution of perioperative mortality to national mortality where these procedures are performed. Methods: We utilized reported surgical metrics with current rates for surgical volume (SV) and perioperative mortality (POMR), as well as World Bank/WHO mortality statistics, to predict the likely impact of surgical scale-up to recommended targets by 2030. We tested correlations between SV and POMR in countries from our region using Pearson's r statistic. Funnel plots were used to evaluate the dataset for outliers. Results: Surgical scale up would result in perioperative mortality contributing on average to 3.3% of all national crude mortality. This prediction assumes POMR stays the same, which is challenging to predict. In our region countries that achieved the LCoGS target (n = 5) had a lower POMR than countries that did not (n = 8). Conclusions: Surgical volumes in the South Pacific region must increase to meet the LCoGS target. Postoperative mortality as a proportion of all mortality may increase with the surgical scale up, however, the overall number of premature deaths is expected to reduce with better access to timely and safe surgical care.