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. 2023 Apr 12;110(5):591-598.
doi: 10.1093/bjs/znad042.

Surgical interhospital transfer mortality: national analysis

Ishraq Murshed  1 , Aashray K Gupta  1   2 , Angelique N Camilos  1 , Ahad Sabab  1 , Stephen Bacchi  1 , Joshua G Kovoor  1   3 , Justin C Y Chan  1   4 , Guy J Maddern  1   3
Affiliations

Surgical interhospital transfer mortality: national analysis

Ishraq Murshed et al. Br J Surg. .

Abstract

Background: Interhospital transfers of surgical patients are an independent risk factor for mortality. The Australian and New Zealand Audit of Surgical Mortality (ANZASM) aims to improve surgical care through assessment of all cases of surgical mortality. This study aimed to describe common clinical management issues that contributed to interhospital transfer patient mortality.

Methods: Data for all surgical patient mortality in Australia (except New South Wales) that underwent interhospital transfer between 1 January 2010 and 31 December 2019 were extracted from ANZASM. The surgeons' reports and assessors' evaluations were examined to identify clinical management issues. Thematic analysis was performed to develop pertinent themes and subthemes.

Results: Some 8679 patients were identified over the 10-year period. Of these, 2171 (25.0 per cent) had 3259 clinical management issues identified. Prominent themes were operative design (n = 466, 14.3 per cent), decision to operate (n = 425, 13.0 per cent), medical conditions (n = 344, 10.6 per cent), diagnosis (n = 326, 10 per cent), transfer (n = 293, 10.0 per cent), intraoperative issues (n = 278, 8.5 per cent), inadequate assessment (n = 238, 7.3 per cent), communication (n = 224, 6.9 per cent), delay in recognizing complications (n = 180, 5.5 per cent), coagulopathy (n = 151, 4.6 per cent), insufficient monitoring (n = 127, 3.9 per cent), infection (n = 107, 3.3 per cent), and hospital resources (n = 100, 3.1 per cent). Assessors considered 58.4 per cent of clinical management issues (n = 1903) probably or definitely preventable.

Conclusion: This study identified 13 themes of potentially avoidable management issues present in surgical mortality following interhospital transfers. Quality-improvement initiatives targeting these areas may improve surgical patient outcomes.

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Figures

Fig. 1
Fig. 1
Flowchart of cases audited by the Australian and New Zealand Audit of Surgical Mortality with inclusion criteria, between 1 January 2010 to 31 December 2019, and the number of clinical management issues (CMIs) identified
Fig. 2
Fig. 2
Percentage of interhospital transfer mortality cases with at least one clinical management issue (CMI)
Fig. 3
Fig. 3
Proportion of interhospital transfer mortality cases with at least one clinical management issue by admitted specialty
Fig. 4
Fig. 4
All interhospital transfer mortality clinical management issues by theme
See this image and copyright information in PMC

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