Technical Factors Affecting Cardiothoracic Surgery Mortality in Australian Hospitals

Justin Chan ¹, Guy Maddern ², Michael Worthington ¹, Glenn McCulloch ³

¹ Royal Adelaide Hospital, Adelaide, Australia; ² Basil Hetzel Institute, Adelaide, Australia; ³ South Australian Audit of Perioperative Mortality, Adelaide, Australia;

Date, time and location: 2018.05.26 10:30, Press Hall, 2F

Abstract

Objective

The outcomes following cardiothoracic surgery in Australia are amongst the best worldwide. Australia has an advantage of having a robust national surgical audit which examines cases of surgical mortality with independent peer review.

This study aims to examine and describe some of the technical factors that can influence cardiothoracic surgery mortality in Australian hospitals. In doing so, we hope to improve the experience of surgeons in avoiding pitfalls during surgery.

Methods

We performed a descriptive study of the Australasian and New Zealand Audit of Surgical Mortality (ANZASM) focussed on cardiothoracic surgery. All mortalities in participating hospitals were reviewed by an independent assessor.

740 cases were reviewed for a 7 year period from February 2009 through to December 2015. Potential issues related to intraoperative, technical issues were highlighted and are described.

Results

Out of 740 cases analysed, a total of 241 technical issues were identified.

85 of these issues related to an injury to a structure during surgery. Common injuries were associated with redo surgery, and structures such as the right ventricle, aorta and previous bypass grafts were involved. Most structural injuries did not directly contribute to the patient’s death.

33 cases were reported of inadequate myocardial protection leading to right ventricular failure in the postoperative setting.

Several “classical” cardiac surgery catastrophes were also described, including 14 cases of aorto-ventricular disruption during mitral valve surgery, and 11 cases of intraoperative aortic dissection.

Conclusions

Although technical factors featured relatively highly in our review, in a majority of cases they did not directly result in patient death, or were deemed to be unavoidable by the assessor.

However, in a minority of cases, potentially preventable issues can be highlighted, which may provide valuable information to improve the conduct of surgery.