Open AccessCritical Analysis of the Causes of In‐Hospital Mortality following Colorectal Resection: A Queensland Audit of Surgical Mortality (QASM) Registry Study
Author(s) -
Mao Derek,
ReyConde Therese,
North John B.,
Lancashire Raymond P.,
Naidu Sanjeev,
Chua Terence C.
Publication year - 2022
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-022-06534-9
Subject(s) - medicine , vascular surgery , cardiothoracic surgery , cardiac surgery , cause of death , abdominal surgery , intensive care unit , general surgery , mortality rate , population , surgery , audit , colon resection , colorectal cancer , colectomy , disease , intensive care medicine , cancer , management , economics , environmental health
Background Colorectal resection is a major gastrointestinal operation. Improvements in peri‐operative care has led to improved outcomes; however, mortalities still occur. Using data from the Queensland Audit of Surgical Mortality (QASM), this study examines the demographic and clinical characteristics of patients who died in hospital following colorectal resection, and also reports the primary cause of death in this population. Methods Patients who died in hospital following colorectal resection in Queensland between January 2010 and December 2020 were identified from the QASM database. Results There were 755 patients who died in the 10 year study period. Pre‐operatively, the risk of death as subjectively determined by operating surgeons was ‘considerable’ in 397 cases (53.0%) and ‘expected’ in 90 cases (12.0%). The patients had a mean of 2.7 (±1.5) co‐morbidities, and a mean American Society of Anaesthesiologists (ASA) score of 3.6 (±0.8). Operations were categorised as emergency in 579 patients (77.2%), with 637 patients (85.0%) requiring post‐operative Intensive Care Unit (ICU) support. The primary cause of death was related to a surgical cause in 395 patients (52.7%) and to a medical cause in 355 patients (47.3%). The primary causes of death were advanced surgical pathology ( n =292, 38.9%), complications from surgery ( n =103, 13.7%), complications arising from pre‐existing medical co‐morbidity ( n =282, 37.6%) or new medical complications unrelated to pre‐existing conditions ( n =73, 9.7%). Conclusions Patients who died had significant co‐morbidities and often presented emergently with an advanced surgical pathology. Surgical and medical causes of death both contributed equally to the mortality burden.