A New report reveals the latest information on death rates from surgery and anaesthesia in New Zealand. The Perioperative Mortality Review Committee (POMRC) today released its third report to the Health Quality & Safety Commission. The POMRC reviews deaths related to surgery and anaesthesia which occur within 30 days of an operation, and makes recommendations aimed at making surgery safer for patients. Its latest report covers deaths from 2007 to 2011 in five clinically important areas: Cholecystectomy (surgical removal of the gallbladder) – death rate of 0.98 percent for emergency admissions and 0.15 percent for elective admissions within 30 days of surgery Colorectal resection (surgical removal of part of the colon) – death rate of 8.46 percent for emergency admissions and 1.7 percent for elective admissions within 30 days of surgery (both figures for patients aged 45 or above) General anaesthesia – death rate of 0.13 percent within one day of surgery Elective admissions for low-risk patients – death rate of 0.06 percent within 30 days of surgery Pulmonary embolism (blood clot in the lung) - death rate of 0.06 percent for emergency admissions and 0.009 percent for elective patients who had surgery/anaesthesia and developed pulmonary embolism. Within 30 days of surgery, there were 555 deaths from colorectal resection (for patients aged 45 and above), 118 deaths from cholecystectomy, and 249 deaths of low-risk patients having anaesthetic during elective surgery. There were 276 deaths from pulmonary embolism within 30 days of surgery, and 136 deaths of people who had surgery/anaesthesia and developed pulmonary embolism. Within a day of surgery, there were 1465 deaths from general anaesthesia. heart disease was the most common underlying reason for dying from general anaesthesia, and the risks of dying significantly increased for patients who were aged over 65, in poor health, and admitted as emergency patients. There have been no clinically significant changes in deaths related to surgery and anaesthesia over the past three years. Dr Leona Wilson, chair of the POMRC, says collecting high-quality data on mortality rates can help measure the safety of health care and identify areas where improvements can be made. “We want operations and anaesthesia to be as safe as possible for all New Zealanders,” she says. The POMRC’s recommendations include ensuring all theatre staff are aware of each patient’s ASA score. Developed by the American Society of Anesthesiologists, ASA scores assess a patient’s physical status before surgery. The committee also recommends that it keeps working with health care providers to develop ways to standardise mortality reporting, and that it continue exploring World Health Organization measures that aim to make it possible to more accurately compare mortality statistics between countries. Third Report of the Perioperative Mortality Review Committee (POMRC) Frequently Asked Questions, embargoed to 18 June 2014: What is POMRC? The Perioperative Mortality Review Committee (POMRC) operates under the umbrella of the Health Quality & Safety Commission (the Commission) and is chaired by Dr Leona Wilson, a specialist anaesthetist working in Wellington. The POMRC reviews deaths related to surgery and anaesthesia which occur within 30 days of an operation. The report published today is the POMRC’s third report to the Health Quality & Safety Commission. It examines death rates from five clinically important areas of surgery and anaesthesia, and makes a series of recommendations. Copies of the report are available from the Commission’s website at www.hqsc.govt.nz. What did the report find? The report looked at deaths from 2007 to 2011 in five clinically important areas: Cholecystectomy (surgical removal of the gallbladder) – death rate of 0.98 percent for emergency admissions and 0.15 percent for elective admissions within 30 days of surgery Colorectal resection (surgical removal of part of the colon) – death rate of 8.46 percent for emergency admissions and 1.7 percent for elective admissions within 30 days of surgery (both figures for patients aged 45 or above) General anaesthesia – death rate of 0.13 percent within one day of surgery Elective admissions for low-risk patients – death rate of 0.06 percent within 30 days of surgery Pulmonary embolism (blood clot in the lung) - death rate of 0.06 percent for emergency admissions and 0.009 percent for elective patients who had surgery/anaesthesia and developed pulmonary embolism. Are there any groups of people who have an increased risk? The report found that patients have a higher risk of dying after a general anaesthetic if they are aged over 65, receive more than one anaesthetic during their admission, are in poorer health, and are admitted as emergency patients. heart disease was the most common underlying reason for dying from general anaesthesia. What recommendations does the committee make? To improve perioperative care, the committee recommends: The ASA Physical Status classification for each patient is collected and communicated to all staff (developed by the American Society of Anesthesiologists, ASA scores assess a patient’s physical status before surgery). The committee considers this is best done during the ‘time-out’ part of the World Health Organization’s surgical safety checklist. Continuing to focus on the risk of venous thromboembolism (a blood clot that forms within a vein). For system development, the committee recommends that it works with health care providers to develop recommendations to standardise perioperative mortality reporting and reviewing. For further analysis, the committee recommends: The proposed World Health Organization measures of surgical care are incorporated into perioperative mortality analysis and reporting. A standard out-of-hospital death notification process be explored as a way of identifying deaths that occurred within 30 days of an operation but after discharge. The Commission considers developing a resource on hospital standardised mortality rates. Where did the data in the report come from? Data was provided by the National Minimum Dataset (NMDS) and the National Mortality Collection (NMC). Both databases have limitations regarding how complete and accurate their information is. For example, the NMDS does not include data from some privately-funded procedures carried out in private hospitals. How do New Zealand’s perioperative mortality rates compare internationally? It is difficult to compare New Zealand’s perioperative mortality data internationally. There are few international reports that consider perioperative mortality across a whole health system, especially relating to surgical procedures. Comparisons between countries, regions or hospitals should be adjusted for the varying mortality risks that occur in different mixes of population demographics, illnesses and other characteristics. Similarly, there are major differences in how hospitals and health care systems are organised, and how data are collected. There are increasing efforts to improve standardisation of data collection and reporting, which would make it easier to make accurate comparisons with other countries. The World Health Organization has developed proposed standardised public health metrics for surgical care. The POMRC is looking into two measures developed by the WHO: day of surgery and postoperative inpatient deaths. Check Full Report Source
