Elderly at risk, says annual audit of surgical deaths

Campaign for public register of surgeons’ performances hits hurdle.

Elderly ‘at risk’ after surgery

The majority of deaths during or immediately after surgery involved elderly patients, according to an annual audit, while a campaign for a public register of surgeons' performances in Australia continues to hit hurdles.

State-by-state audits are released every year by the Royal Australian College of Surgeons (RACS), with the latest, reporting on surgical deaths in Victoria, attributing most to elderly patients with underlying health problems and who were admitted in emergency situations.

In the past financial year, 805 clinical reviews were conducted in Victoria in cases where patients died while under the care of a surgeon, the audit reported.

“The actual cause of death was often non-preventable and linked to their pre-existing health status,” it said.

The 2018 annual report also contains information on 8375 deaths reported over the past five years. Of these deaths, 5348 had gone through the audit process with the remaining cases still under review.

A British doctor says information on surgeons' performance in the UK has been publicly available since 2014 and argues that there should be a similar system in Australia.

The surgeon ‘league tables’ were set up in the UK as a way of improving standards.

Surgeon performance is measured according to such things as patient survival rates and number of operations performed.

British cardiothoracic anaesthetist Andrew Klein argues that the tables offer patients and their families a valuable tool when selecting a surgeon.

"If it was my mother or my wife or any member of my family, I would want to know which hospital they are going to and details about the surgeon, including their patient mortality rates," he told news.com.

“For the patient, if the surgeon has nothing to hide then it should be published because people ‘do fear death’.”

While supporting the annual audits, RACS was less enthusiastic about a register based on the UK model.

RACS president John Batten said he was open to greater transparency regarding surgeon performance, but stopped short of supporting league tables that would be publicly available.

He warned that careers would be destroyed under such a move.

“If you made that public, what would happen?" said Dr Batten. "That would be the end of that surgeon’s career."

He also argued that league tables would drive up hospital waiting times and that identifying surgeons who were not meeting performance standards was the responsibility of the whole hospital system.

A recent RACS national report made specific recommendations in relation to surgical risks for the elderly.

It said: “The patient should be transferred to a medical unit if very frail, elderly, high risk, and if medical issues are assessed as being the prominent clinical factor during the admission episode, providing that the surgical post-operative care can be performed appropriately in that setting.

“Time delays are to be minimised, particularly for elderly frail patients transferred between hospitals due to their limited physiological reserves. Time delays for these patients can significantly affect surgical outcomes.”

Would you like to see a public register of surgeons set up in Australia? Are you confident in the current system of referrals?

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    COMMENTS

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    Marian
    4th Jun 2018
    10:19am
    In Australia from evidence who we past is 98% Death in any Hospital in Australia is fabricate evidence by Police or any others investigation the is also evidence i ours family Multiple medicals negligence in N.S.W fabrication all legal documents bu Coroners N.S.W. Governments & health departments in the crime is connect to I.C.A.C. G.I.O all solicitors & all in N.S.W Supreme Courts Appeal Court Cost assessments Fake Statements of Claim by all Solicitors Attorney Judges L.S.C. all complaints Crown Solicitors O.D.P.P.Judicial Commission & all is fake print in the N.S.W. Medical Bulletin also cover up by N.S.W law Society & Bar association all act as connect mafia again the who safer as ours family we left Australia from abuse all legal system in 2009 to Europe all is in Europe law & U.N.& the all criminals is work today in the legal system The is all the system crime
    KSS
    4th Jun 2018
    12:42pm
    If I understand this correctly you don't approve of the medical, legal or justice professions in Australia, Europe and elsewhere as every member of any of these professions are all in cahoots with each other and conspiring against you and your family.

    If this were true I would be absolutely in awe that no-one across at least 2 continents (or in the UN) has broken ranks and provided evidence of such amazing and total collusion.
    patti
    4th Jun 2018
    10:58am
    At 74 and about to undergo foot repair surgery followed by a knee replacement, this really doesn't fill me with confidence.
    Pass the Ductape
    4th Jun 2018
    5:30pm
    I'm in the exact same boat patti. Major operation this Thursday and hoping like hell I make it after reading this!
    tisme
    4th Jun 2018
    11:36am
    mum went into hospital to have a cataract removed. they wouldn't let me go in with her. when I went to pick her up it turns out that she had high blood pressure but they still did the op any way, and they discharged her with high blood pressure. all it took was a call to our gp who upped her meds by one pill. but that was obviously too much work for this hospital she wasn't the same afterwards
    Charlie
    4th Jun 2018
    11:54am
    I was in hospital and had pain that was causing the blood pressure to soar, but they said it was risky to give medication that would cause the blood pressure to drop too suddenly. So I continued to have high blood pressure. It is of course a risk factor for stroke.

    This was like 220/100. It slowly went down to what is normally considered high 180/85, but it is not unusual for me to have this, so they were not as concerned as they would be, for a person with normal blood pressure and suddenly going sky high.
    Charlie
    4th Jun 2018
    11:39am
    Very hard for anyone to give an informed answer to this one. For me I would rather they bump me off completely, than do something to give me more hardship than I already have.
    Pass the Ductape
    4th Jun 2018
    5:32pm
    That ain't gunna happen Charlie. Ain't enough money in it for them!
    Charlie
    4th Jun 2018
    7:53pm
    Should have known I couldn't get a win out of it.
    BrianP
    4th Jun 2018
    12:19pm
    Simple really - standards that are publicly available should be set for ALL services professions. That way any provider with a poor record would get less "business" or be out altogether.

    No way should a surgeon who kills too many people be allowed to continue. Anyway what happened to allowing patients to decide for themselves what happens to their lives?
    KSS
    4th Jun 2018
    12:33pm
    But that ignores the surgeons who take the most difficult or challenging cases who also run the most risk of losing a patient. Charlie Teo is a case in point. He attempts the most complex brain surgery when virtually all other brain surgeons say nothing can be done. He has his successes but also many failures and is on the outer of the medical fraternity for his methods. Yet which neurosurgeon would you want operating on your family member?

    Without more information on the type of cases any given surgeon works on, data such as how many are lost on the operating table or in recovery after surgery are totally meaningless.
    Anonymous
    5th Jun 2018
    8:10pm
    Absolutely, BrianP.
    KSS
    4th Jun 2018
    12:26pm
    What problem are they trying to solve? ALL medical interventions carry risk and especially surgery under general anaesthetic. Ultimately there is no 100% safe operation only a risk factor. That is why you are told multiple times what is going to happen along with what might happen and you sign you fully understand the risks.

    Operating on elderly patients with underlying conditions simply ups that risk. No wonder then that many do not make it through. Instead of then going on a witch hunt for someone to blame, perhaps the better option is not to operate in the first place if the risk is too high. Sometimes it is kinder to do nothing. Sadly though, there will still be those who would then sue the surgeon for not operating despite the risk.
    MD
    5th Jun 2018
    8:23pm
    Yes, good call KSS, I'd reckon you're pretty much spot on.

    I'm constantly amazed by the expectations of people in advanced years seeking the fountain of youth with the expectation some brilliant quack will render them the service. To be sure, a good many legitimate cases are worthy of the surgeons knife, if, for no other reason than to alleviate pain or suffering. Currently it seems as though everyone expects to live forever yet quite the opposite is far likelier with each passing year. Age seems to warp patient's expectations of what quacks are capable of. Just let one poor 'knife wielder' trip up and failing to extend the life of some old fart, look out - all hell breaks loose - compliments of the dearly departed's family .
    The aging process increases the susceptibility of problems arising from surgery and further diminishes the rate of recovery. The effect of standard procedure operations differs from patient to patient and outcome may well be determined partly by the patients lifestyle.
    Of course doctors advise associated risks but ultimately no guarantees exist.

    Nobody has a right on life and for that reason nobody should expect quacks to perform miracles, they are human after all and hence prone to mistakes. Surgery is a voluntary undertaking (forgive pun), no-one is compelled. Some folk just don't know when to call it quits.
    gillygally
    4th Jun 2018
    3:42pm
    Unrelated to this topic but a comment on socks for senior foot pain. Can absolutely endorse these socks for plantar fasciitis sufferers but purchase them for $5 to $6 on ebay. Heck of a difference. You might wait but at least you can get s/m/l and not one size fits all. Also on ebay some aussie sites have them a lot cheaper than what is in the ad on this site. Do they every check the content of their ads.

    5th Jun 2018
    8:10pm
    It's shocking that we still DON'T have a public register where anyone can see the performance of any Medical Specialist including and especially surgeons. Not only for deaths, but also feedback from Patients (or immediate relatives if patient didn't survive) about how successful the Service provided was (comparing it to the predicted expectations), including the level of agreed Risk before the surgery took place.

    We need some backbone from our politicians to not get rolled over by the medical profession who naturally don't want their performance to be reviewed. The PUBLIC WANTS IT!
    MD
    5th Jun 2018
    8:29pm
    Yeh right George, yet another forum for bitching, whinging, moaning and groaning - enough already. The PUBLIC HAVE LITTLE IDEA OF WHAT THEY WANT! They just think they do.
    Anonymous
    6th Jun 2018
    12:35am
    MD, clearly you have an ulterior motive - maybe an ex / current Medical practitioner? The PUBLIC DOES know what they want - they are simply not getting what they want due to vested interests (such as you, AMA, RACS, etc) obstructing discussions / discouraging opinions on public forums. Your arrogance is astounding!
    In this internet age, a lot of services (other than medical) already have reviews out there - but a public register by a responsible agency would be the best way to get accurate information for this important area.


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