Use of the Australian and New Zealand Audit of Surgical Mortality (ANZASM) to determine potentially preventable deaths after emergency general surgery

BACKGROUND: Patients undergoing emergency general surgery procedures have significantly greater mortality rates than those undergoing the same procedures electively. However, the exact number of potentially preventable deaths after these procedures is unclear. This study aims to examine potentially preventable and nonpreventable deaths after 7 common emergency general surgery procedures and the clinical management issues associated with potentially preventable deaths. METHODS: A retrospective analysis of surgical deaths after 7 emergency general surgery procedures-laparotomy, colectomy, adhesiolysis, cholecystectomy, peptic ulcer repair, small bowel resection, and appendectomy-was conducted on Australian and New Zealand Audit of Surgical Mortality data between 2010 and 2022. Deaths were classified into 2 groups: potentially preventable or nonpreventable. RESULTS: Within the study period, 875 deaths (18.5%) were potentially preventable, and 3,848 deaths (81.5%) were not preventable. Potentially preventable deaths had significantly greater rates of overall postoperative complications (57.0% vs 37.0%, P < .001) compared with nonpreventable deaths. The potentially preventable deaths group had also significantly greater rates of clinical management issues in the preoperative (38.6% vs 7.0%, P < .001), intraoperative (21.4% vs 3.2%, P < .001), and postoperative (20.5% vs 4.0%, P < .001) phases of care. CONCLUSION: Among the most common emergency general surgery procedures, approximately 20% of deaths are potentially preventable. For patients with potentially preventable deaths, the majority of clinical management issues occurred during the preoperative phase of care. The overall clinical management issues identified relate to 14 separate areas of patient care. Further quality improvement projects, such as enhanced recovery after surgery protocols, should address these areas of clinical management issues to improve future patient mortality rates.