Sean S Davis1, Wendy J Babidge1,2, Andreas Kiermeier3, R James Aitken2, Guy J Maddern4,5. 1. University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, 28 Woodville Rd, Woodville South, SA, 5011, Australia. 2. Australia and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, 199 Ward St, North Adelaide, SA, 5006, Australia. 3. Statistical Process Improvement Consulting and Training Pty Ltd, Adelaide, SA, Australia. 4. University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, 28 Woodville Rd, Woodville South, SA, 5011, Australia. college.asernip@surgeons.org. 5. Australia and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, 199 Ward St, North Adelaide, SA, 5006, Australia. college.asernip@surgeons.org.
Abstract
INTRODUCTION: Oesophagectomy (OG) and pancreaticoduodenectomy (PD) remain associated with significant perioperative mortality rates (POMR). Improved outcomes in high-volume centres have led to these procedures being centralised in some countries. This retrospective, population-based cohort study was conducted to determine the Australian national, and state and territory based POMR associated with OG and PD, and assess trends over time. METHODS: Logistic regression analysis was performed using de-identified procedural data between 1 July 2005 and 30 June 2013 from the Australian Institute of Health and Welfare. Codes relating to OG and PD contained in the Australian Classification of Health Interventions were used to extract patient data. Mortality rates were risk adjusted for age, gender and urgency of admission. Temporal trends and differences between states/territories were investigated. RESULTS: The average Australian POMR throughout the study period was 3.5 and 3.0% for OG and PD, respectively. OG POMR showed no significant change over time (P = 0.30) or variation between states (P = 0.079). The annual POMR associated with PD, however, showed a significant decrease during the study period (P = 0.01) with variation in PD POMR outcomes evident amongst different regions (P = 0.0004). CONCLUSION: This study demonstrates a comparable Australian PD and OG POMR when correlated with international studies. National PD POMR improved throughout the study with consistent improvement across the states and territories. This study does, however, show variation in PD POMR between states and territories. Potential intra-state variation merits further investigation.
INTRODUCTION: Oesophagectomy (OG) and pancreaticoduodenectomy (PD) remain associated with significant perioperative mortality rates (POMR). Improved outcomes in high-volume centres have led to these procedures being centralised in some countries. This retrospective, population-based cohort study was conducted to determine the Australian national, and state and territory based POMR associated with OG and PD, and assess trends over time. METHODS: Logistic regression analysis was performed using de-identified procedural data between 1 July 2005 and 30 June 2013 from the Australian Institute of Health and Welfare. Codes relating to OG and PD contained in the Australian Classification of Health Interventions were used to extract patient data. Mortality rates were risk adjusted for age, gender and urgency of admission. Temporal trends and differences between states/territories were investigated. RESULTS: The average Australian POMR throughout the study period was 3.5 and 3.0% for OG and PD, respectively. OG POMR showed no significant change over time (P = 0.30) or variation between states (P = 0.079). The annual POMR associated with PD, however, showed a significant decrease during the study period (P = 0.01) with variation in PD POMR outcomes evident amongst different regions (P = 0.0004). CONCLUSION: This study demonstrates a comparable Australian PD and OG POMR when correlated with international studies. National PD POMR improved throughout the study with consistent improvement across the states and territories. This study does, however, show variation in PD POMR between states and territories. Potential intra-state variation merits further investigation.
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